Pharmaceutical treatment status of patients with COPD in the community based on medical Internet of Things: a real-world study.

This study aimed to investigate the real-world standardisation and adherence of medical treatment regimens in patients with chronic obstructive pulmonary disease (COPD) in the community for making future management strategy. The follow-up data and treatment information of patients with COPD, which were collected through the Management Information Center of COPD (MICCOPD) in 21 community health service centres in Songjiang District, a countryside region of Shanghai. Concordance between the pharmaceutical treatment plan and recommendation of 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report during the follow-up management period, as well as the medication adherence by patients,were analysed. Out of the 2044 patients diagnosed with COPD, 814 patients (39.8%) who had an initial record of medication use were found to meet the inclusion criteria. The most common medication regimens were long-acting beta-agonist plus inhaled corticosteroids (35.9%) and oral bronchodilators (41.9%). Among these 814 patients, 45.7%, 38.0%, 31.6% and 14.6% adhered to the treatment after 6, 12, 18 and 24 months of follow-up, respectively. The concordance rate with the regimens recommended by the 2017 GOLD guidelines was 35.5% at baseline, 35.5% at 6 months, 32.7% at 12 months, 35.4% at 18 months and 37% at 24 months. The compliance and guideline consistency rates of patients with COPD in the community under the management of general practitioners need to be improved. Enhancing general practitioner proficiency in the prevention and management of COPD and increasing patient awareness of the condition, are crucial standardising and improving adherence to initial and follow-up COPD treatments.

CRISPR/Cas12a-assisted visible fluorescence for pseudo dual nucleic acid detection based on an integrated chip.

BACKGROUND: A false negative result is one of the major problems in nucleic acid detection. Failure to screen positive samples for pathogens or viruses poses a risk to public health. This situation will lead to more serious consequences for infectious pathogens or viruses. At present, the common solution is to introduce exogenous or endogenous internal control. Because it amplifies and is detected separately from the target gene, it cannot avoid false negative results caused by DNA extraction failure or reagent inactivation. There is an urgent need for a simple and reliable method to solve the false negative problem of nucleic acid detection. RESULTS: We established a chip and an on-chip detection method for the integrated detection of target genes and internal control using the CRISPR system in LAMP amplification products. The chip is processed from a low-cost PMMA board and has three chambers and some channels. After adding the sample, the chip only needs to be rotated twice, and the sample enters three chambers successively depending on its gravity for dual LAMP reaction and CRISPR detections. With a portable LED blue light exciter, visual fluorescence detection is realized. Whether the detection result is positive, negative, or invalid can be determined according to the fluorescence in the CRISPR chamber for target gene and CRISPR chamber for internal control. In this study, the detection of Salmonella enterica in Fenneropenaeus chinensis was taken as an example. The results showed good specificity and sensitivity. It could detect as low as 15 copies/µL of Salmonella enterica. SIGNIFICANCE: The on-chip detection solves the problem of aerosol contamination and false negative results. It has the advantages of high sensitivity, high specificity, high accuracy, and low cost. This research will advance the development of nucleic acid detection technology, providing a new and reliable strategy for POCT detection of pathogenic bacteria and viruses.

Real-World COPD Management Over 3 Years at the Community Health Service Center of Shanghai During the COVID-19 Pandemic in China.

Objective: To evaluate the real-world situation for the management of chronic obstructive pulmonary disease (COPD) and poorly controlled disease risk factors in the Chinese community. Methods: This retrospective multicentre study analysed data from COPDMICand MICHC in Shanghai Songjiang District, Shanghai, China. The differences in COPD Assessment Test (CAT), the modified Medical Research Council (mMRC) dyspnea scale, and the number of emergency cases, emergency visits, inpatient cases, and hospitalisations from January 2018 to December 2020 were analysed. The impact of coronavirus disease 2019 (COVID-19) on COPD management was also assessed. Results: For 2020 versus 2018, analysis of 468 COPD cases from COPDMIC matched with MICHC data showed significantly more patients with improved mMRC grades, significantly fewer emergency cases and emergency visits, and significantly fewer hospitalisation cases and hospitalisations. Differences in the number of emergency visits and hospitalisations per capita were statistically significant. Compared to GOLD 3-4, GOLD 1-2 patients showed significant improvements in CAT score, mMRC grade, the number of emergency visits and hospitalisations per capita. Treatment adherence from 2018 to 2020 was 25%, 29.1%, and 6.8%, and the proportion of medication regimens consistent with guidelines was 43.44%, 50.98%, and 71.87%, respectively. Higher treatment adherence resulted in significantly improved CAT scores and mMRC grades and fewer emergency department visits and hospitalisations per capita. Conclusion: Combined with remote management tools, patients with COPD achieved continuous improvement in symptoms and exacerbations over 3 years. In the context of COVID-19 prevention/control measures, improvements were significant for patients with GOLD 1-2 COPD but limited with GOLD 3-4. Pharmacologic treatment significantly improved clinical symptoms and reduced emergency visits and hospitalisations. Severe airflow limitation and poor adherence to pharmacologic treatment were important risk factors for lack of disease remission.

Dipstick-based rapid nucleic acids purification and CRISPR/Cas12a-mediated isothermal amplification for visual detection of African swine fever virus.

African swine fever virus (ASFV) can cause highly contagious and fatal disease among domestic pigs, resulting in considerable economic losses for swine breeders. There is a strong demand for accurate, rapid, and simple detection methods especially for on-site application. Nucleic acid testing is the most commonly used method for ASFVdetection. However, traditional nucleic acid purification step is time- and labor-consuming. The nucleic acid purification, amplification and amplicons detection rely on laboratory settings which limits the on-site detection. Here, we proposed a simple and cost-effective detection method that utilized filter paper to purify nucleic acids from swine blood and employed CRISPR/Cas12a-mediated loop-mediated isothermal amplification (LAMP) reaction to detect ASFV. The filter paper which was made into dipsticks could effectively purify nucleic acids from whole blood in 2 min. This simple and low-cost purification method avoided multiple pipetting steps and potential amplification inhibitors (e.g., ethanol) that were generally used in traditional nucleic acids extraction processes. After nucleic acid purification, the lyophilized LAMP reagent dissolved by elution solution was employed to perform isothermal amplification reaction on a portable heating block. The CRISPR/Cas12a system was designed to specifically detect amplicons. Assisted by a portable homemade device, the fluorescent signals produced by positive samples could be observed by the naked eye, while negative samples remained colorless. The whole detection procedure could be finished within 50 min with a detection limit of one copies/µL. This established method provided a novel strategy for rapid visualized detection and showed great potential for on-site application.

Genomic evolution and virulence association of Clostridioides difficile sequence type 37 (ribotype 017) in China.

Clostridioides difficile sequence type (ST) 37 (ribotype 017) is one of the most prevalent genotypes circulating in China. However, its genomic evolution and virulence determinants were rarely explored. Whole-genome sequencing, phylogeographic and phylogenetic analyses were conducted for C. difficile ST37 isolates. The 325 ST37 genomes from six continents, including North America (n = 66), South America (n = 4), Oceania (n = 7), Africa (n = 9), Europe (n = 138) and Asia (n = 101), were clustered into six major lineages, with region-dependent distributions, harbouring an array of antibiotic-resistance genes. The ST37 strains from China were divided into four distinct sublineages, showing five importation times and international sources. Isolates associated with severe infections exhibited significantly higher toxin productions, tcdB mRNA levels, and sporulation capacities (P < 0.001). Kyoto Encyclopedia of Genes and Genomes analysis showed 10 metabolic pathways were significantly enriched in the mutations among isolates associated with severe CDI (P < 0.05). Gene mutations in glycometabolism, amino acid metabolism and biosynthesis virtually causing instability in protein activity were correlated positively to the transcription of tcdR and negatively to the expression of toxin repressor genes, ccpA and codY. In summary, our study firstly presented genomic insights into genetic characteristics and virulence association of C. difficile ST37 in China. Gene mutations in certain important metabolic pathways are associated with severe symptoms and correlated with higher virulence in C. difficile ST37 isolates.

Comparison of xMAP Salmonella Serotyping Assay With Traditional Serotyping and Discordance Resolution by Whole Genome Sequencing.

Salmonella spp. are a major cause of foodborne illness throughout the world. Traditional serotyping by antisera agglutination has been used as a standard identification method for many years but newer nucleic acid-based tests have become available that may provide advantages in workflow and test turnaround time. In this study, we evaluated the Luminex® xMAP® Salmonella Serotyping Assay (SSA), a multiplex nucleic acid test capable of identifying 85% of the most common Salmonella serotypes, in comparison to the traditional serum agglutination test (SAT) on 4 standard strains and 255 isolates from human (224), environmental, and food (31) samples. Of the total of 259 isolates, 256 could be typed by the SSA. Of these, 197 (77.0%) were fully typed and 59 (23.0%) were partially typed. By SAT, 246 of the 259 isolates (95%) were successfully typed. Sixty isolates had discrepant results between SAT and SSA and were resolved using whole genome sequencing (WGS). By SAT, 80.0% (48/60) of the isolates were consistent with WGS while by SSA 91.7% (55/60) were partially consistent with WGS. By serovar, all 30 serovars except one tested were fully or partially typable. The workflow comparison showed that SSA provided advantages over SAT with a hands-on time (HOT) of 3.5 min and total turnaround time (TAT) of 6 h, as compared to 1 h HOT and 2-6 days TAT for SAT. Overall, this study showed that molecular serotyping is promising as a rapid method for Salmonella serotyping with good accuracy for typing most common Salmonella serovars circulating in China.

[Comparative study on laparoscopic vaginoplasty using pedicled ileal and sigmoid colon segment transfer].

OBJECTIVE: To study the clinical effect of laparoscopic vaginoplasty using pedicled ileal and sigmoid colon segment. METHODS: From January 2004 to December 2009, 105 cases undergoing laparoscope-assisted vaginoplasty using a vascularized pedicled intestinal flap were studied retrospectively. Operation time, blood loss in operating, bowel movement after operation, postoperation hospital duration, side effect, and artificial vagina were compared between two surgical management. RESULTS: The vaginoplasty were preformed successfully in all 105 cases. There were 48 patients treated by aparoscope-assisted ileal vaginoplasty and 57 patients treated by laparoscope-assisted sigmoid colon vaginoplasty. The values of the operation time [(141 ± 22) minutes versus (159 ± 18) minutes, P = 0.000], blood loss in operating [(42 ± 6) ml versus (83 ± 14) ml, P = 0.000], bowel movement after operation (36 ± 9) hours versus (68 ± 8) hours(P = 0.000), and postoperation hospital duration [(9.8 ± 2.0) days versus (11.1 ± 1.3) days, P = 0.004] in the sigmoid colon vaginoplasty group were longer or higher than those in ileal vaginoplasty group (P < 0.05).No intraoprative complication occurred. There were four postoperative complications: 2 cases with intestinal obstruction in sigmoid colon vaginoplasty group, 1 case with urethral orifice stenosis and 1 case with vaginal-rectal fistula in ileal vaginoplasty group. At follow-up of 6-62 months, all artificial vaginas had a capacity of over two fingers in wideness and 12-15 cm in length. Vaginal discharges resembled a milky white water or mucus without odour. Fifty-five patients with sexual intercourse reported satisfactory results.Six patients complained vaginal stenosis:5 patients in ileal vaginoplasty group and 1 patient in sigmoid colon vaginoplasty group. CONCLUSIONS: Laparoscope-assisted vaginoplasty using pedicled ileum or sigmoid colon segment are both the effective ways in forming vagina. The latter management takes more time and blood loss while operating, yet the incidence of vaginal opening contracture appeared to be decreasing trend.

[Maternal and fetal outcomes in pregnant patients undergoing cardiac surgery with cardiopulmonary bypass].

OBJECTIVE: To evaluate the optimal management of cardiac surgery during pregnancy, and the maternal and fetal outcomes in pregnant patients undergoing cardiac surgery with the use of cardiopulmonary bypass. METHODS: Nine pregnant women with heart diseases were identified, who underwent cardiac surgery with cardiopulmonary bypass between January 2002 and March 2013. Patient charts were reviewed for pregnant age, types of heart diseases, surgical indication, parameters of cardiopulmonary bypass, and maternal and fetal outcomes. RESULTS: Among 9 patients, there were 4 cases of valvular heart disease (two of rheumatic heart disease complicated with subacute bacterial endocarditis and heart failure, one of mechanical prosthetic valves flap after mitral replacement, one of severe aortic stenosis), one case of aortic dissection, three cases with atrial myxoma, and one case with tetralogy of Fallot. The New York Heart Association (NYHA) functional classification: there were three cases with class I, two with class II, two with class III, and two with class IV. Heart surgeries were performed from 9 to 39 weeks gestation. Five patients underwent heart surgery with cardiopulmonary bypass combined with cesarean section. The other 4 patients terminated pregnancies after heart surgeries, two of whom underwent uterine curettage in first trimester, one induction of labor in second trimester, and one continued to be pregnant until 37 weeks' gestation. Seven patients were alive. Nine fetal outcomes were included two with artificial abortion, one with induction of labor and one with cesarean section in second trimester, two of premature labor and three of full-term labor with cesarean section in third trimester. Five newborns were no malformation, four of whom were alive. CONCLUSION: Cardiopulmonary bypass can be used safely with satisfactory maternal and fetal outcomes in pregnant patients with heart disease undergoing cardiac surgery.

[Study on gasless-laparoscopic vaginoplasty using sigmoid colon segment].

OBJECTIVE: To study the clinical effect of gasless-laparoscopic vaginoplasty using sigmoid colon segment. METHODS: Clinical data of 119 cases undergoing laparoscopic or gasless-laparoscopic vaginoplasty using a vascularized pedicled sigmoid colon segment in Beijing Anzhen Hospital from January 2007 to December 2010 were reviewed retrospectively. Those patients were classified into 57 cases with laparoscopic sigmoid colon vaginoplasty and 62 cases with gasless-laparoscopic sigmoid colon vaginoplasty. The operation time, blood loss in operating, bowel movement after operation, postoperation hospital duration, side effect, and artificial vagina were compared between laparoscopic and gasless-laparoscopic group. RESULTS: The vaginoplasty were preformed successfully in 119 cases. The mean operation time of were (159 ± 18) min in laparoscopic group and (146 ± 17) min in gasless-laparoscopic group, respectively, which reached statistical difference (P < 0.01). The blood loss in operating were (83 ± 14) ml and (86 ± 13) ml, bowel movement after operation were (68 ± 8) hours and (68 ± 11) hours, and postoperation hospital duration were (11.1 ± 1.3) days and (11.4 ± 1.9) days respectively in laparoscopic group and gasless-laparoscopic group. No significant difference were found in the blood loss in operating, bowel movement after operation, and postoperation hospital duration between two groups (P > 0.05) .No intraoperative complication occurred. There were two cases with incomplete adhesive intestinal obstruction at 15-20 days postoperatively, which one was in laparoscopic group and one was in gas-less laparoscopic group. At 6-50 months of following up (median time 12 months), all artificial vaginas had a capacity of over two fingers in wideness and 12-15 cm in length. Vaginal discharges resembled a milky white water or mucus without odour. Eighty-five patients with sexual intercourse reported satisfactory feeling. One patients complained vaginal stenosis in laparoscopic group. CONCLUSION: Gasless-laparoscopic vaginoplasty using sigmoid colon segment is an alternative feasible and practical treatment.

Laparoscopic management or laparoscopy combined with transvaginal management of type II cesarean scar pregnancy.

OBJECTIVE: To evaluate the clinical effectiveness of laparoscopic management of cesarean scar pregnancy (CSP) by deep implantation. BACKGROUND: A pregnancy implanting within the scar from a previous cesarean delivery is a rare condition of ectopic pregnancy. There are two different types of CSPs. Type I is caused by implantation of the amniotic sac on the scar with progression toward either the cervicoisthmic space or the uterine cavity. Type II (CSP-II) is caused by deep implantation into a previous CS defect with infiltrating growth into the uterine myometrium and bulging from the uterine serosal surface, which may result in uterine rupture and severe bleeding during the first trimester of pregnancy. Thus, timely management with an early and accurate diagnosis of CSP-II is important. However, laparoscopic management in CSP-II has not yet been evaluated. METHODS: Eleven patients with CSP-II underwent conservative laparoscopic surgery or laparoscopy combined with transvaginal bilateral uterine artery ligation and resection of the scar with gestational tissue and wound repair to preserve the uterus from March 2008 to November 2011. Patients with CSP-II were diagnosed using color Doppler sonography, and the diagnosis was confirmed by laparoscopy. The operation time, the blood loss during surgery, the levels of ß-human chorionic gonadotropin (ß-hCG) before surgery, the time taken for serum ß-hCG levels to return to <100 mIU/mL postoperatively, and the time for the uterine body to revert to its original state were retrospectively analyzed. RESULTS: All 11 operations were successfully performed using laparoscopy with preservation of the uterus. One patient underwent a dilation and curettage after laparoscopic bilateral uterine artery ligation. Eight patients were treated solely by laparoscopic bilateral uterine artery ligation and resection of the scar with gestational tissue and wound repair. The remaining two patients underwent laparoscopic bilateral uterine artery ligation and transvaginal resection of the CS with gestational tissue and wound repair because of dense adhesions and heavy bleeding. The average operation time was 85.5 (±17.5) minutes, and the blood loss was 250.0 (±221.4) mL. The blood serum level of ß-hCG returned to <100 mIU/mL in 16.4 (±5.3) days postoperatively. Among the 10 patients who underwent resection of CS and wound repair, the time for the uterus to revert to its original state (judged by ultra-sonography) was 10.8 (±3.0) days postoperatively. CONCLUSIONS: Laparoscopy can remove ectopic gestational tissue and allow subsequent wound repair, as well as provide diagnostic confirmation. Being a minimally invasive procedure, laparoscopic or laparoscopy combined with transvaginal bilateral uterine artery ligation and resection of the scar with gestational tissue and wound repair can become an effective alternative for the treatment of CSP-II.

Molecular cloning and characterization of hatching enzyme-like geneII (BmHELII) in the silkworm, Bombyx mori.

Hatching enzyme (HE) is an enzyme that digests an egg envelop at the time of embryo hatching. Previously, we have reported a kind of Bombyx mori hatching enzyme-like gene (BmHEL). In this paper, the full length of another BmHEL cDNA sequence (BmHELII, GenBank ID: JN627443) was cloned from bluish-silkworm-eggs. The cDNA was 977 bp in length with an open reading frame of 885 bp which encodes a polypeptide of 294 amino acids including a putative signal peptide of 16 amino acid residues and a mature protein of 278 amino acids. The deduced BmHELII had a predicted molecular mass of 33.62 kDa, isoelectric point of 5.44 and two conserved signature sequences of astacin family. Bioinformatic analysis results showed that the deduced protease domain amino acid sequence of BmHELII had 29.5-87.0% identities to that of HE identified in the other species. The BmHELII gene structure was 6-exon-5-intron, and the promoter region harbored some basal promoter elements and some embryo development related transcription factor binding sites. Semi-quantitative RT-PCR analysis revealed that the relative level of BmHELII transcripts at different stages during egg incubation increased with the development of embryos and reached to a maximum just before hatching, hence declined gradually after hatching. The spatio-temporal expression pattern of BmHELII basically resembled that of hatching enzyme gene. Moreover, the BmHELII transcript was detected in testis of the silkworm, and semi-quantitative RT-PCR analysis showed that it kept at the high level in testis of silkworm from larvae to moth, which suggested that BmHELII might take part in the development of sperm. These results will be helpful to provide a molecular basis for understanding the mechanism underlying silkworm hatching as well as spermatogenesis.

[Preparation and catalytic activity of surface-modification CNTs/TiO2 composite photocatalysts].

A novel kind of carbon nanotubes/titanium dioxide (CNTs/TiO2) composite photocatalyst was prepared by a modified sol-gel method in which the nanoscaled TiO2 particles were uniformly deposited on the CNTs modified with poly(vinyl pyrrolidone) (PVP). The composites were characterized by a range of analytical techniques including high resolution transmission electron microscopy (TEM), X-ray diffraction (XRD), and X-ray photoelectron spectroscopy (XPS). The results show the successful covering of the CNTs with PVP, forming core-shell structure. The nanoscaled TiO2 particles were uniformly deposited on the surface of CNTs reducing the bare CNTs which avoid losing the absorption and scattering of photons. The combination of CNTs and TiO2 particles imply the enhanced interactions between the CNTs and TiO2 interface which possibly becomes heterojunction. The composites become mesoporous crystalline TiO2 (anatase) clusters after annealing at 500 degrees C, and the surface area increases obviously. The photocatalytic activities of surface modification CNTs/TiO2 (smCNTs/TiO2) composites are extremely enhanced from the results of the photodegradation of methylene blue (MB).

[Mechanism study of fluoride adsorption by hydrous metal oxides].

Hydrous oxides of cerium, aluminum, nickel and copper were prepared by alkaline precipitation method. Langmuir adsorption isotherm was studied and specific surface area was measured by BET method through N2 adsorption-desorption process. IR characterization of hydrous metal oxides before and after fluoride adsorption was also studied. Results show that different hydrous metal oxides have different specific surface areas and their pore size distributions also are not all the same. Adsorption capacity is not directly dependent on the specific surface area. Isotherm study indicates that the adsorption follows Langmuir model and shows the feature of monolayer adsorption. IR study before and after fluoride adsorption shows that different hydrous metal oxides have similar adsorption sites in the same IR region as well as adsorption sites in the different IR region. The comprehensive interaction of these adsorption sites with fluoride ions results in the different adsorption capacity of different hydrous metal oxides.

[Removal of methyl orange from aqueous solution by magnetic carbon nanotubes].

Ferrocene was used as a catalyst, and xylene as carbon source. Chemical vapor deposition method was used to synthesize carbon nanotubes (CNTs). The CNTs were treated by oxidation method with concentrated nitric acid. Magnetic carbon nanotubes were prepared by using chemical co-precipitation. The products were characterized by field emission scanning electron microscope. This paper is concerned with the adsorption of methyl orange by magnetic carbon nanotubes. The best experimental conditions were found. Adsorbent solution was analyzed by UV-Vis adsorption spectra. At the same time, desorption and re-adsorption of methyl orange from magnetic CNTs were studied.

[Clinical study on laparoscopic technique for vaginoplasty using an ileum with long vascular pedicle].

OBJECTIVE: To study the operative methods and clinical outcome of laparoscopic ileal colpopoiesis with long vascular pedicle. METHODS: We reviewed 31 cases which had received ileal colpopoiesis, including 25 cases of congenital absence of vagina and 6 cases of male-to-female trans-sex. All cases were operated on by laparoscopic (8 cases) and laparoscopy assisted (23 cases) ileal colpopoiesis. The postoperative results were analyzed through physical examination and interview regarding the patient's functional status and satisfaction during sexual intercourse. RESULTS: Ileal colpopoiesis were preformed successfully on all 31 cases. Follow-ups of 3-13 months were done for all of them. Patients used vaginal mould for at least 8 months. All artificial vaginas had excellent cosmetic results, including adequate vaginal length, good lubrication, and appearance and physical functions similar to female natural vagina, and sexual function was reportedly satisfactory. One of the patients had an operative complication of an intestinal obstruction, which was cured by a second operation and other treatments. CONCLUSIONS: The laparoscopic and laparoscopy assisted ileal vaginoplasty is a feasible, safe and ideal method of current vaginoplasty due to its minor damage, excellent cosmetic results and similarity to normal vaginal features. However, vaginal mould should be used for a long period of time (at least 8 months) after an operation, to prevent vaginal orifice shrinkage.

[Women's postpartum sexuality and delivery types].

OBJECTIVE: To investigate the impact of delivery on the sexuality of primiparous women in China, and the association with delivery type. METHODS: We inquired 460 of primiparous women delivering of a live birth at the first affiliated hospital of Chongqing medical university from November 1, 2000 to July 31, 2001. It was a cross-sectional study using obstetric records and postal questionnaire survey by outpatients consultation six months after delivery. RESULTS: Ninety-four point seven percent had resumed sexual activity within six months of the birth. In the first three months after delivery, 70.6% of women experienced sexual problems, it declined to 34.2% at six months, but can not reaching the pre-pregnancy levels. There was no close relation between sexuality postpartum and delivery. (sexual satisfactory, desire, active rate, dyspareunia and pubococcygeal muscle intensity, P > 0.05). CONCLUSIONS: Postpartum sexuality was not significantly associated with delivery types. Sexual problems were very common after childbirth. More consultation and direction of postpartum sexuality recurrence is needed.