Emergence of OXA-232 Carbapenemase-Producing Klebsiella pneumoniae That Carries a pLVPK-Like Virulence Plasmid among Elderly Patients in China.

This study reported the clonal dissemination of OXA-232-producing sequence type 15 (ST15) carbapenem-resistant Klebsiella pneumoniae among elderly patients in China. All patients were immunocompromised, suffered from multiple underlying diseases, and were hospitalized for a prolonged period; however, they slowly recovered on antimicrobial therapy. The blaOXA-232 gene was in a 6.1-kb ColKP3-type nonconjugative plasmid. The strains displayed a multidrug resistance phenotype and were not hypervirulent despite harboring a virulence plasmid. Active surveillance should be enforced to control further transmission.

Simultaneous adsorption of ciprofloxacin and Cu2+ using Fe and N co-doped biochar: Competition and selective separation.

The treatment of combined antibiotics and heavy metals pollution is a critical challenge. Herein, iron and nitrogen co-doped biochar (Fe/N-BC) was synthesized using rape straw as precursor, and applied for the adsorption of ciprofloxacin (CIP) and Cu2+ in single and binary systems. The qmax for CIP and Cu2+ were 46.45 mg g-1 and 30.77 mg g-1, respectively. Adsorption decreased in a binary matrix, indicating that there was a competitive effect between CIP and Cu2+, which might be due to CIP and Cu2+ sharing similar active adsorption sites on Fe/N-BC. Interestingly, CIP and Cu2+ co-adsorption was a pH-dependent process. Fe/N-BC has potential to highly selectively separate CIP/Cu2+ from mixed solutions through adjusting pH values. Furthermore, adsorption mechanisms were systematically investigated in this research. This research could help to provide a deeper understanding of the synchronously removing specific antibiotics and heavy metals by biochar adsorbents.

Synergistic adsorption and oxidation of trivalent antimony from groundwater using biochar supported magnesium ferrite: Performances and mechanisms.

Antimony (Sb) pollution is considered an environmental problem, since Sb is toxic and carcinogenic to humans. Here, a novel biochar supported magnesium ferrite (BC@MF) was adopted for Sb(III) removal from groundwater. The maximum adsorption capacity was 77.44 mg g-1. Together with characterization, batch experiments, kinetics, isotherms, and thermodynamic analyses suggested that inner-sphere complexation, H-bonding, and electrostatic interactions were the primary mechanisms. C-C/CC, C-O, and O-CO groups and Fe/Mg oxides might have acted as adsorption sites. The adsorbed Sb(III) was oxidized to Sb(V). The generation of reactive oxygen species, iron redox reaction, and oxidizing functional groups all contributed to Sb(III) oxidation. Furthermore, the fixed-bed column system demonstrated a satisfactory Sb removal performance; BC@MF could treat ∼6060 BV of simulated Sb-polluted groundwater. This research provides a promising approach to sufficiently remove Sb(III) from contaminated groundwater, providing new insights for the development of innovative strategies for heavy metal removal.

[Value of early enteral nutrition in patients with severe heart failure undergoing mechanical ventilation].

OBJECTIVE: To observe the effect of early enteral nutrition (EEN) on nutritional indicators and clinical outcomes in patients with severe heart failure undergoing mechanical ventilation. METHODS: Thirty-four patients with severe heart failure (grade III-IV of cardiac function) and pulmonary infections undergoing mechanical ventilation admitted to intensive care unit (ICU) of Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from May 2017 to April 2018 were enrolled. They were randomly divided into EEN group and delayed enteral nutrition (DEN) group. Both groups were given routine treatment, including mechanical ventilation, improvement of cardiac function, anti-infection, protection of vital organ function, regulation of blood sugar and adjustment of electrolyte and acid-base balance. The patients in EEN group received enteral nutrition (EN) within 48 hours after ICU admission, and in DEN group, EN was started after the patients had spent the early stage of stress and had stable vital signs (48 hours after ICU admission). The changes in serum B-type natriuretic peptide (BNP), C-reactive protein (CRP), nutritional indicators and liver function indicators at ICU admission and 7 days after treatment were compared between the two groups. The time needed for patients to reach EN target, duration of mechanical ventilation, length of ICU stay, and the 28-day mortality were recorded, and complications were observed. RESULTS: There was no significant difference in serum BNP, CRP, nutritional indicators or liver function indicators at ICU admission between the two groups. After treatment for 7 days, BNP and CRP in both groups were decreased significantly as compared with those at ICU admission [BNP (ng/L): 592.1±370.9 vs. 2 517.7±1 163.4 in EEN group, 621.9±418.8 vs. 2 251.5±1 006.8 in DEN group; CRP (mg/L): 46.0±19.6 vs. 59.8±22.5 in EEN group, 40.5±18.8 vs. 61.2±24.6 in DEN group, all P < 0.05], pre-albumin (PA) and transferrin (TF) were significantly increased [PA (g/L): 0.18±0.05 vs. 0.15±0.06 in EEN group, 0.17±0.04 vs. 0.12±0.06 in DEN group; TF (g/L): 1.6±0.4 vs. 1.5±0.4 in EEN group, 1.7±0.5 vs. 1.4±0.5 in DEN group, all P < 0.05]. However, there was no significant difference in the above indicators after treatment between the two groups (all P > 0.05). There was no significant change in liver function after treatment in both groups. The EN treatment was successfully completed in both groups. Some patients developed abdominal distension and diarrhea in varying degrees, which were alleviated by slowing down the infusion rate, supplemented by gastrointestinal motility drugs and intestinal flora adjustment drugs. The time needed to reach EN target in EEN group was significantly earlier than that in DEN group (hours: 42.4±10.2 vs. 53.8±17.1, P < 0.05), the duration of mechanical ventilation (days: 14.2±8.7 vs. 13.4±7.9), the length of ICU stay (days: 17.8±6.7 vs. 18.3±5.6) and 28-day mortality [5.9% (1/17) vs. 11.8% (2/17)] showed no significant difference as compared with those in DEN group (all P > 0.05), and it did not increase the incidence of aspiration pneumonia [23.5% (4/17) vs. 17.7% (3/17), P > 0.05]. CONCLUSIONS: EEN could help to achieve nutritional goals as soon as possible, improve the nutritional status of the body, and provide conditions and basis for further treatment of severe heart failure patients.

A novel approach for enriching cancer stem cells from the human SW-13 adrenocortical carcinoma cell line.

The present study was undertaken to develop a new method for enriching cancer stem cells (CSCs) from the human adrenal cortical carcinoma (ACC) cell line SW-13. Given that the existence of CSCs in ACC causes resistance to conventional chemotherapies, treatment with cyclophosphamide was used for in vivo selection of CSCs in a BALB/c nude mouse tumor xenograft model established using the ACC cell line SW-13. The characteristics of CSCs in three generations of tumor xenografts were assessed for single-cell colony formation, flat colony formation, and cell sphere formation in serum-free suspension culture. The formation rates of single-cell colonies, flat colonies, and cell spheres were significantly higher for tumor xenograft cells treated with cyclophosphamide than for untreated engrafted tumor cells. Flow cytometry to examine expression of the CSC markers C-X-C chemokine receptor type-4 (CXCR4; CD184) and ATP-binding cassette sub-family G member-2 (ABCG2; CDw338) revealed markedly higher levels of CXCR4 and ABCG2 in cyclophosphamide-treated xenograft tumor cells compared to untreated tumor cells. Together, these results indicate that cyclophosphamide treatment of tumor xenograft cells caused enrichment of CSCs with a strong capability for self-renewal and proliferation. In this method, the administration of cyclophosphamide selectively kills cancer cells without toxicity to CSCs and thereby provides a practical approach for achieving the enrichment of CSCs in ACC.