The incidence of surgical site infections in China.

Surgical site infections (SSIs) are a common type of healthcare-associated infection. We performed a literature review to demonstrate the incidence of SSIs in mainland China based on studies since 2010. We included 231 eligible studies with ≥30 postoperative patients, comprising 14 providing overall SSI data regardless of surgical sites and 217 reporting SSIs for a specific site. We found that the overall SSI incidence was 2.91% (median; interquartile range: 1.05%, 4.57%) or 3.18% (pooled; 95% confidence interval: 1.85%, 4.51%) and the SSI incidence varied remarkably according to the surgical site between the lowest (median, 1.00%; pooled, 1.69%) in thyroid surgeries and the highest (median, 14.89%; pooled, 12.54%) in colorectal procedures. We uncovered that Enterobacterales and staphylococci were the most common types of micro-organisms associated with SSIs after various abdominal surgeries and cardiac or neurological procedures, respectively. We identified two, nine, and five studies addressing the impact of SSIs on mortality, the length of stay (LOS) in hospital, and additional healthcare-related economic burden, respectively, all of which demonstrated increased mortality, prolonged LOS, and elevated medical costs associated with SSIs among affected patients. Our findings illustrate that SSIs remain a relatively common, serious threat to patient safety in China, requiring more action. To tackle SSIs, we propose to establish a nationwide network for SSI surveillance using unified criteria with the aid of informatic techniques and to tailor and implement countermeasures based on local data and observation. We highlight that the impact of SSIs in China warrants further study.

Ambient air pollution exposure and telomere length: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to provide evidence of the associations between pre- and post-birth and adulthood air pollution exposure with telomere length. STUDY DESIGN: The databases of PubMed, Embase, and Web of Science were searched up to June 1st, 2022 in order to include relevant observational studies and perform a systematic review and meta-analysis. METHODS: The random-effects meta-analysis was grouped by air pollutant and exposure window (pre- and post-birth and adulthood) to evaluate the summary effect estimate. Cochran's Q and I2 statistics were used to evaluate the heterogeneity among the included studies. The quality of individual studies was evaluated using the national toxicology program/office of health assessment and translation risk of bias rating tool. RESULTS: We identified 18 studies, covering 8506 children and 2263 adults from multiple countries. We found moderate evidence that particulate matter less than 2.5 µm (PM2.5) exposure during the entire pregnancy (-0.043, 95% CI: -0.067, -0.018), nitrogen dioxide (NO2) exposure during the first trimester (-0.016, 95% confidence interval [CI]: -0.027, -0.005), long-term adulthood PM2.5 exposure were associated with shortening telomere length. Mild to high between-study heterogeneity was observed for the most tested air pollutant-telomere length combinations in different exposure windows. CONCLUSIONS: This systematic review and meta-analysis provides the evidence which strongly supports that prenatal PM2.5 and NO2 exposures were related to reduced telomere length, while prenatal sulfur dioxide (SO2) and carbon monoxide (CO) exposures, childhood PM2.5, particulate matter less than 10 µm (PM10), NO2 exposures and short-term adulthood PM2.5 and PM10 exposures were not associated with telomere length. Further high-quality studies are needed to elaborate our suggestive associations.

[Interpretation of group standard for Clostridioides difficile infection diagnosis].

Clostridioides difficile is a key pathogen of antibiotic related diarrhea and hospital associated infection, causing several outbreaks in Europe and North Americans and resulting in severe disease burden. However, the standardized diagnostic principle and detection specifications in C. difficile infection (CDI) survey are limited in China, and the infection rate and disease burden of CDI in China are unclear. Therefore, National Institute for Communicable Disease Control and Prevention,National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, together with another 11 institutions, draft the group standard entitled "Diagnosis of Clostridium difficile infection (T/CPMA 008-2020)" of Chinese Preventive Medicine Association. Based on the principle of "legality, scientificity, advancement, and feasibility", this standard clarifies risk factors, diagnosis principles, diagnoses and differential diagnoses in order to improve the accuracy of CDI diagnosis in clinical practice, guide the surveillance for CDI, and understand the infection rate and disease burden of CDI in China.

Spinal anaesthesia for patients with coronavirus disease 2019 and possible transmission rates in anaesthetists: retrospective, single-centre, observational cohort study.

BACKGROUND: The safety of performing spinal anaesthesia for both patients and anaesthetists alike in the presence of active infection with the novel coronavirus disease 2019 (COVID-19) is unclear. Here, we report the clinical characteristics and outcomes for both patients with COVID-19 and the anaesthetists who provided their spinal anaesthesia. METHODS: Forty-nine patients with radiologically confirmed COVID-19 for Caesarean section or lower-limb surgery undergoing spinal anaesthesia in Zhongnan Hospital, Wuhan, China participated in this retrospective study. Clinical characteristics and perioperative outcomes were recorded. For anaesthesiologists exposed to patients with COVID-19 by providing spinal anaesthesia, the level of personal protective equipment (PPE) used, clinical outcomes (pulmonary CT scans), and confirmed COVID-19 transmission rates (polymerase chain reaction [PCR]) were reviewed. RESULTS: Forty-nine patients with COVID-19 requiring supplementary oxygen before surgery had spinal anaesthesia (ropivacaine 0.75%), chiefly for Caesarean section (45/49 [91%]). Spinal anaesthesia was not associated with cardiorespiratory compromise intraoperatively. No patients subsequently developed severe pneumonia. Of 44 anaesthetists, 37 (84.1%) provided spinal anaesthesia using Level 3 PPE. Coronavirus disease 2019 infection was subsequently confirmed by PCR in 5/44 (11.4%) anaesthetists. One (2.7%) of 37 anaesthetists who wore Level 3 PPE developed PCR-confirmed COVID-19 compared with 4/7 (57.1%) anaesthetists who had Level 1 protection in the operating theatre (relative risk reduction: 95.3% [95% confidence intervals: 63.7-99.4]; P<0.01). CONCLUSIONS: Spinal anaesthesia was delivered safely in patients with active COVID-19 infection, the majority of whom had Caesarean sections. Level 3 PPE appears to reduce the risk of transmission to anaesthetists who are exposed to mildly symptomatic surgical patients.

Handwashing sinks as the source of transmission of ST16 carbapenem-resistant Klebsiella pneumoniae, an international high-risk clone, in an intensive care unit.

Carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates (carrying the carbapenemase gene blaNDM-5) of sequence type 16 caused hospital-acquired bloodstream infection or gut colonization in two patients in an intensive care unit (ICU). It was hypothesized that handwashing sinks were the source, and all handwashing sinks in the ICU were sampled. Whole-genome sequencing and analysis revealed that one sink was the source of CRKP colonization/infection in both patients, instead of direct transmission of a common clone between the patients. This study highlights handwashing sinks as an important source of multi-drug-resistant organisms. Sink management, including prohibition of disposal of body fluids and daily disinfection with chlorine, curbed the transmission.

Analysis on clinical characteristics and drug resistance of Candida parapsilosis bloodstream infections in West China Hospital, China, from 2012 to 2015.

OBJECTIVE OF THE STUDY: Candida parapsilosis has emerged as an important cause of bloodstream infections (BSI) in the health care setting. We aimed to describe the clinical characteristics and drug resistance of C. parapsilosis BSI in West China Hospital of Sichuan University in China and provide the basis for prevention and treatment of this disease. PATIENTS: We retrospectively collected and analyzed patients presented in our hospital reported with C. parapsilosis BSI from January 2012 to January 2015. MATERIALS AND METHODS: Data regarding age, gender, the department distribution, the potential clinical risk factors and the result of clinical treatment and prognosis were retrospectively evaluated. As to the antifungal drugs susceptibility testing, we used Etest method for determining the minimum inhibitory concentrations (MICs) of amphotericin B, fluconazole, voriconazole, caspofungin and flucytosine for all the clinical isolates of C. parapsilosis. Standard quality strains were used as the controls. RESULTS: Most of the patients with C. parapsilosis BSI were over 60-year-old (37.5%) or within 10years old (28.13%). Among patients, 78.13% came from an intensive care unit or had undergone surgery in the past several months. The major risk factors associated with an increased risk of infection included the use of broad-spectrum antibacterial drugs and deep vein indwelling. The overall mortality of patients with C. parapsilosis BSI was 31.25%. The drug sensitivity tests revealed that all isolates were sensitive to amphotericin B and flucytosine. Two and 1 isolates were found susceptible to fluconazole and voriconazole in a dose-dependent manner, respectively. Only 1 isolate was resistant to fluconazole. 4 isolates (12.5%) were medium sensitive to caspofungin, but no one showed drug resistance. CONCLUSION: In summary, elders and newborns were more vulnerable to C. parapsilosis infections. C. parapsilosis was found frequently as pathogens leading to BSI in patients admitted to ICU and departments of surgery and often causing a high mortality rate. C. parapsilosis rarely showed drug resistance at present, so common antifungal drugs could be used for treatment. Recommendations for using of antifungal drugs focused on paying close attention to possible drug resistance trend.

MiR-129-5p is down-regulated and involved in migration and invasion of gastric cancer cells by targeting interleukin-8.

Expression of microRNA-129-5p (miR-129-5p) has been reported to decrease in gastric cancer (GC). However, little information is available about how miR-129-5p affects cell migration and invasion of GC. Cancer samples and matched non-tumor adjacent tissues were obtained from patients with GC. Besides, peripheral blood samples were collected from both the patients and healthy volunteers. Expression of miR-129-5p was analyzed by real-time PCR (RT-PCR). After transfection with miR-129-5p mimics, miR-129-5p inhibitor, or negative controls in human GC cell line SGC-7901, cell viability, colony-formation ability, migration, and invasion assay were evaluated. Luciferase reporter assay, RT-PCR, and enzyme-linked immunosorbent assay (ELISA) were performed to explore whether interleukin-8 was a target of miR-129-5p. Further, small interfering RNA (siRNA) against IL-8 was transfected into cells, and then the effects of miR-129-5p inhibitor on migration and invasion were assessed. MiR-129-5p was down-regulated in both GC samples and blood samples compared to their matched non-tumor adjacent tissues and healthy volunteers (both P < 0.05). Compared to the control group, transfection with miR-129-5p inhibitor markedly increased the cell viability, colony-forming ability, and numbers of migrated and invaded cells. Luciferase reporter assay confirmed that IL-8 was a direct target of miR-129-5p, and IL-8 was negatively regulated by miR-129-5p. Co-transfection of miR-129-5p inhibitor with si-IL-8 reversed the effect of miR-129-5p inhibitor on the migration and invasion of the cells. MiR-129-5p and regulates migration and invasion of GC cells by targeting IL-8.

Correlation of cadherin-17 protein expression with clinicopathological features and prognosis of patients with sporadic gastric cancer

This study aimed to explore the correlations between cadherin-17 (CDH17) protein expression and the clinicopathological features and prognosis of patients with sporadic gastric cancer (GC). Nine relevant studies of 1,960 patients were identified using electronic database searches supplemented with a manual search in strict accordance with inclusion and exclusion criteria. Statistical analyses were conducted using STATA 12.0 statistical software. Relative risks and 95% confidence intervals were determined, and Z test was used to measure the significance of the overall effect size. A total of nine eligible cohort studies were included in this meta-analysis. The expression of CDH17 in patients with diffuse GC was significantly higher than in those with intestinal-type GC. Moreover, the tumor depth of invasion differed significantly between patients with positive CDH17 (CDH17+) and negative CDH17 (CDH17-) GC. However, there were no significant differences between CDH17+ and CDH17- GC patients with respect to tumor node metastasis clinical stages, histological grades, or lymph node metastasis. Despite the differences in invasive depth, there was no significant difference in 5-year survival rates between CDH17+ and CDH17- GC patients. Our meta-analysis provides evidence that CDH17 protein expression may be associated with the development of GC, suggesting that CDH17 is an important biomarker that could be useful for the early diagnosis of GC. However, CDH17 levels do not appear to impact overall survival.

Correlation of cadherin-17 protein expression with clinicopathological features and prognosis of patients with sporadic gastric cancer.

This study aimed to explore the correlations between cadherin-17 (CDH17) protein expression and the clinicopathological features and prognosis of patients with sporadic gastric cancer (GC). Nine relevant studies of 1,960 patients were identified using electronic database searches supplemented with a manual search in strict accordance with inclusion and exclusion criteria. Statistical analyses were conducted using STATA 12.0 statistical software. Relative risks and 95% confidence intervals were determined, and Z test was used to measure the significance of the overall effect size. A total of nine eligible cohort studies were included in this meta-analysis. The expression of CDH17 in patients with diffuse GC was significantly higher than in those with intestinal-type GC. Moreover, the tumor depth of invasion differed significantly between patients with positive CDH17 (CDH17+) and negative CDH17 (CDH17-) GC. However, there were no significant differences between CDH17+ and CDH17- GC patients with respect to tumor node metastasis clinical stages, histological grades, or lymph node metastasis. Despite the differences in invasive depth, there was no significant difference in 5-year survival rates between CDH17+ and CDH17- GC patients. Our meta-analysis provides evidence that CDH17 protein expression may be associated with the development of GC, suggesting that CDH17 is an important biomarker that could be useful for the early diagnosis of GC. However, CDH17 levels do not appear to impact overall survival.

IncA/C Plasmid Carrying bla(NDM-1), bla(CMY-16), and fosA3 in a Salmonella enterica Serovar Corvallis Strain Isolated from a Migratory Wild Bird in Germany.

A Salmonella enterica serovar Corvallis strain was isolated from a wild bird in Germany. This strain carried the IncA/C2 pRH-1238 plasmid. Complete sequencing of the plasmid was performed, identifying the blaNDM-1, blaCMY-16, fosA3, sul1, sul2, strA, strB, aac(6')-Ib, aadA5, aphA6, tetA(A), mphA, floR, dfrA7, and merA genes, which confer clinically relevant resistance to most of the antimicrobial classes, including ß-lactams with carbapenems, fosfomycin, aminoglycosides, co-trimoxazole, tetracyclines, and macrolides. The strain likely originated from the Asiatic region and was transferred to Germany through the Milvus migrans migratory route.

Knockdown of BAG3 induces epithelial-mesenchymal transition in thyroid cancer cells through ZEB1 activation.

The process by which epithelial features are lost in favor of a mesenchymal phenotype is referred to as epithelial-mesenchymal transition (EMT). Most carcinomas use this mechanism to evade into neighboring tissues. Reduction or a loss of E-cadherin expression is a well-established hallmark of EMT. As a potent suppressor of E-cadherin, transcription factor ZEB1 is one of the key inducers of EMT, whose expression promotes tumorigenesis and metastasis of carcinomas. Bcl-2-associated athanogene 3 (BAG3) affects multifaceted cellular functions, including proliferation, apoptosis, cell adhesion and invasion, viral infection, and autophagy. Recently, we have reported a novel role of BAG3 implicated in EMT, while the mechanisms are poorly elucidated. The current study demonstrated that knockdown of BAG3 induced EMT, and increased cell migratory and invasiveness in thyroid cancer cells via transcriptional activation of ZEB1. We also found that BAG3 knockdown led to nuclear accumulation of ß-catenin, which was responsible for the transcriptional activation of ZEB1. These results indicate BAG3 as a regulator of ZEB1 expression in EMT and as a regulator of metastasis in thyroid cancer cells, providing potential targets to prevent and/or treat thyroid cancer cell invasion and metastasis.

Hetastarch with hypertonic saline loading is a better choice for the maintenance of systemic and pulmonary circulation during general and epidural anesthesia.

AIM: Sufficient volume load prior to major surgery is important for better management of anesthesia. In this study we assessed systemic and pulmonary hemodynamic stabilization following a load of hypertonic saline plus hydroxyethyl starch (HHS) solution during anesthesia in elective hepatobiliary surgical patients. METHODS: Thirty-six hepatobiliary surgical patients, ASA physical status I~II, were randomly and double-blindly divided into: HHS (4 mL/kg) group, hydroxyethyl starch (7 mL/kg) group (HES group) and Ringer's solution (7 mL/kg) group (RL group). All the patients underwent general anesthesia and epidural anesthesia. Mean pulmonary artery pressure (MPAP), pulmonary artery wedge pressure (PAWP), right ventricular-stroke work (RVSW) and pulmonary vascular resistance (PVR) were recorded to monitor pulmonary circulation; systemic vascular resistance (SVR), cardiac output (CO) and stroke volume (SV) were recorded to monitor systemic circulation. These parameters were recorded before infusion (T0), 10 min after infusion (T1), 5 min after induction (T2), 5, 10 and 20 min after intubation (T3, T4 and T5, respectively). RESULTS: In pulmonary circulation, MPAP, PAWP and RVSW were increased at T1 compared to T0 in both HES and HHS groups, the latter being more marked at T1. Pulmonary PVR was decreased in both HHS and HES groups compared to RL group during T2 to T5. In systemic circulation, SVR was decreased in both HHS and HES groups during T1 to T5 compared to RL group. CO and SV were increased at T1 compared to T0 in both HHS and HES groups, and they also increased during T1 to T5 in HHS group compared to RL group. CONCLUSION: HHS solution was superior in maintaining systemic and pulmonary circulation during general anesthesia combined epidural anesthesia.

Safety of the Las Vegas left-turn display.

This paper provides a safety evaluation of a special protected/permitted left turn signal control (Las Vegas LT Display) that has been implemented in the urbanized area of Las Vegas, Nevada. The Las Vegas LT Display eliminates the yellow trap condition for leading approach in lead/lag operation. It provides protected only left turns during certain times of day by suppressing the permitted green ball and yellow ball displays. Before and after studies were conducted using the crash data from 10 intersections. Results from the analyses indicated that no obvious safety concerns due to use of the special display.

Radioiodine therapy for patients with differentiated thyroid cancer after thyroidectomy: direct comparison and network meta-analyses.

BACKGROUND AND OBJECTIVES: The effective dose of radioiodine 131 (I-131) ablation for patients with differentiated thyroid cancer (DTC) after thyroidectomy was unclear, so we tried to find out which activity is the best using the methods of direct comparison and network meta-analyses. METHODS: Direct comparison and network meta-analyses were conducted with ADDIS software. Randomized controlled trials (RCT) which compared different activities of I-131 after thyroidectomy for adult patients with DTC were included. The outcomes we evaluated were successful remnant ablation rate, duration of stay in an isolation unit, the number of subsequent I-131 treatments required, recurrence rate, and adverse effects. RESULTS: Thirteen RCT (3352 patients) were included. Our network meta-analysis demonstrated that there were not any statistical differences in successful ablation rates among all comparisons except 100 mCi vs 15 mCi. However, rank probability plot suggested 60 mCi might be the best in successful ablation rate. For recurrence rate, both direct comparison and network meta-analyses showed no statistical differences among 100 mCi, 60 mCi, and 30 mCi; 100 mCi was associated with a smaller number of patients who required subsequent I-131 treatments and longer stay in an isolation unit than 30 mCi without any more adverse events. CONCLUSION: Because of conflicting results between direct comparison and network meta-analyses, we failed to conclude which activity of I-131 is the best in successful ablation rates.

PKCδ-mediated phosphorylation of BAG3 at Ser187 site induces epithelial-mesenchymal transition and enhances invasiveness in thyroid cancer FRO cells.

Protein kinase C delta (PKCδ) is a serine (Ser)/threonine kinase, which regulates numerous cellular processes, including proliferation, differentiation, migration and apoptosis. In the current study, Chinese hamster ovary cells were transfected with either a constitutively activated PKCδ or a dominant negative PKCδ, phosphoprotein enrichment, two-dimensional difference gel electrophoresis and mass spectrometry was combined to globally identified candidates of PKCδ cascade. We found that Bcl-2 associated athanogene 3 (BAG3) was one of the targets of PKCδ cascade, and BAG3 interacted with PKCδ in vivo. In addition, we clarified that BAG3 was phosphorylate at Ser187 site in a PKCδ-dependent manner in vivo. BAG3 has been implicated in multiple cellular functions, including proliferation, differentiation, apoptosis, migration, invasion, macroautophagy and so on. We generated wild-type (WT)-, Ser187Ala (S187A)- or Ser187Asp (S187D)-BAG3 stably expressing FRO cells, and noticed that phosphorylation state of BAG3 influenced FRO morphology. Finally, for the first time, we showed that BAG3 was implicated in epithelial-mesenchymal transition (EMT) procedure, and phosphorylation state at Ser187 site had a critical role in EMT regulation by BAG3. Collectively, the current study indicates that BAG3 is a novel substrate of PKCδ, and PKCδ-mediated phosphorylation of BAG3 is implicated in EMT and invasiveness of thyroid cancer cells.

Acinetobacter baumannii isolates associated with community-acquired pneumonia in West China.

Acinetobacter baumannii has emerged as an important cause of community-acquired infection. To characterize the microbiological and genotypic features of community-associated Acinetobacter baumannii, 32 isolates associated with community-acquired pneumonia were collected. These isolates were diverse in resistance patterns and had multiple clonal origins. bla(OXA-23) was the main acquired oxacillinases-encoding gene detected.