Antimicrobial susceptibility, virulence determinants profiles and molecular characteristics of Staphylococcus epidermidis isolates in Wenzhou, eastern China.

BACKGROUND: Staphylococcus epidermidis has emerged as an often encountered pathogen responsible for hospital-acquired infections. The aim of present study is to investigate the microbiological characteristic of S. epidermidis isolates isolated from sterile specimens and skin in a Chinese tertiary hospital. METHODS: A total of 223 non-duplicate S. epidermidis were collected from various sterile specimens of inpatients among 10 years in Wenzhou, China. 106 S. epidermidis obtained from the skin (urethral orifices) of healthy volunteers. All isolates were tested for antimicrobial susceptibility. PCR was used to detect the virulence- and resistance-associated genes and 7 housekeeping genes to determine the sequence types (STs) of selected isolates. RESULTS: The resistance rates to antimicrobials tested except linezolid and vancomycin and the prevalence of methicillin-resistant S. epidermidis (MRSE) of S. epidermidis clinical isolates were significantly higher than those among colonized isolates (P < 0.05). The positive rates of virulence-associated genes including aap, sesI, ACME-arcA, IS256, bhp, altE, aae and gehD for S. epidermidis clinical isolates were significantly higher than those for colonized isolate (P < 0.05). A total of 60 STs including 28 from clinical isolates and 32 from colonized isolates were identified by MLST. A novel, rarely encountered clone, ST466, was found to be the second prevalent clone among clinical isolates. The great majority of the S. epidermidis isolates tested (73.86%) belonged to clone complex 2 (CC2). Compared with ST2, ST130, ST20 and ST59 clones, ST466 clone had the highest resistance rate to tetracycline (50.00%), the second highest prevalence of ACME-arcA (65.00%), bhp (30.00%) and qacA/B (65.00%), very low prevalence of carriage of icaA (0.00%) and biofilm formation (0.00%), the lack of sesI and high prevalence of aap, altE and aae (> 90%), which was similar to the characteristics of ST59 clone with one locus difference from ST466. ST466 clone competence with Staphylococcus aureus was relatively stronger, relative to ST2, ST20, ST130 and ST59 clones. CONCLUSION: Taken together, a high-level of genetic diversity was found between clinical and colonized S. epidermidis isolates. A novel ST466 clone with distinct and similar characteristics relative to other prevalent clones, emerging as a prevalent clone in China, should be of major concern.

Fluctuation-driven selection at criticality in a frustrated magnetic system: the case of multiple-k partial order on the pyrochlore lattice.

We study the problem of partially ordered phases with periodically arranged disordered (paramagnetic) sites on the pyrochlore lattice, a network of corner-sharing tetrahedra. The periodicity of these phases is characterized by one or more wave vectors k={1/21/21/2}. Starting from a general microscopic Hamiltonian including anisotropic nearest-neighbor exchange, long-range dipolar interactions, and second- and third-nearest neighbor exchange, we use standard mean-field theory (SMFT) to identify an extended range of interaction parameters that support partially ordered phases. We demonstrate that thermal fluctuations ignored in SMFT are responsible for the selection of one particular partially ordered phase, e.g., the "4-k" phase over the "1-k" phase. We suggest that the transition into the 4-k phase is continuous with its critical properties controlled by the cubic fixed point of a Ginzburg-Landau theory with a four-component vector order parameter. By combining an extension of the Thouless-Anderson-Palmer method originally used to study fluctuations in spin glasses with parallel-tempering Monte Carlo simulations, we establish the phase diagram for different types of partially ordered phases. Our results elucidate the long-standing puzzle concerning the origin of the 4-k partially ordered phase observed in the Gd2Ti2O7 dipolar pyrochlore antiferromagnet below its paramagnetic phase transition temperature.

JAML inhibits colorectal carcinogenesis by modulating the tumor immune microenvironment.

It is necessary to explore new targets for the treatment of colon adenocarcinoma (COAD) according to the tumor microenvironment. The expression levels of JAML and CXADR were analyzed by bioinformatics analysis and validation of clinical samples. JAML over-expression CD8+ T cell line was constructed, and the proliferation activity was detected by MTT. The production of inflammatory factors was detected by ELISA. The expression of immune checkpoint PD-1 and TIM-3 was detected by Western blot. The apoptosis level was detected by flow cytometry and apoptosis markers. The AOM/DSS mouse model of colorectal cancer was constructed. The expression levels of JAML, CXADR and PD-1 were detected by PCR and Western blot, and the proportion of CD8+ T cells and exhausted T cells were detected by flow cytometry. The expression levels of JAML and CXADR were significantly decreased in colon cancer tissues. Overexpression of JAML can promote the proliferation of T cells, secrete a variety of inflammatory factors. Overexpression of CXADR can reduce the proliferation of colorectal cancer cells, promote apoptosis, and down-regulate the migration and invasion ability of tumor cells. Both JAML agonists and PD-L1 inhibitors can effectively treat colorectal cancer, and the combined use of JAML agonists and PD-L1 inhibitors can enhance the effect. JAML can promote the proliferation and toxicity of CD8+ T cells and down-regulate the expression of immune checkpoints in colon cancer. CXADR can inhibit the proliferation of cancer cells and promote the apoptosis. JAML agonist can effectively treat colorectal cancer by regulating CD8+ T cells.

ING3 inhibits the malignant progression of lung adenocarcinoma by negatively regulating ITGB4 expression to inactivate Src/FAK signaling.

Lung adenocarcinoma (LUAD) is the most commonly diagnosed subtype of lung cancer worldwide. Inhibitor of growth 3 (ING3) serves as a tumor suppressor in many cancers. This study aimed to elucidate the role of ING3 in the progression of LUAD and investigate the underlying mechanism related to integrin ß4 (ITGB4) and Src/focal adhesion kinase (FAK) signaling. ING3 expression in LUAD tissues and the correlation between ING3 expression and prognosis were analyzed by bioinformatics databases. After evaluating ING3 expression in LUAD cells, ING3 was overexpressed to assess the proliferation, cell cycle arrest, migration and invasion of LUAD cells. Then, ITGB4 was upregulated to observe the changes of malignant activities in ING3-overexpressed LUAD cells. The transplantation tumor model of NCI-H1975 cells in nude mice was established to analyze the antineoplastic effect of ING3 upregulation in vivo. Downregulated ING3 expression was observed in LUAD tissues and cells and lower ING3 expression predicated the poor prognosis. ING3 upregulation restrained the proliferation, migration, invasion and induced the cell cycle arrest of NCI-H1975 cells. Additionally, ITGB4 expression was negatively correlated with ING3 expression in LUAD tissue. ING3 led to reduced expression of ITGB4, Src and p-FAK. Moreover, ITGB4 overexpression alleviated the effects of ING3 upregulation on the malignant biological properties of LUAD cells. It could be also found that ING3 upregulation limited the tumor volume, decreased the expression of ITGB4, Src and p-FAK, which was restored by ITGB4 overexpression. Collectively, ING3 inhibited the malignant progression of LUAD by negatively regulating ITGB4 expression to inactivate Src/FAK signaling.

A Novel Public Sentiment Analysis Method Based on an Isomerism Learning Model via Multiphase Processing.

The dissemination of public opinion in the social media network is driven by public sentiment, which can be used to promote the effective resolution of social incidents. However, public sentiments for incidents are often affected by environmental factors such as geography, politics, and ideology, which increases the complexity of the sentiment acquisition task. Therefore, a hierarchical mechanism is designed to reduce complexity and utilize processing at multiple phases to improve practicality. Through serial processing between different phases, the task of public sentiment acquisition can be decomposed into two subtasks, which are the classification of report text to locate incidents and sentiment analysis of individuals' reviews. Performance has been improved through improvements to the model structure, such as embedding tables and gating mechanisms. That being said, the traditional centralized structure model is not only easy to form model silos in the process of performing tasks but also faces security risks. In this article, a novel distributed deep learning model called isomerism learning based on blockchain is proposed to address these challenges, the trusted collaboration between models can be realized through parallel training. In addition, for the problem of text heterogeneity, we also designed a method to measure the objectivity of events to dynamically assign the weights of models to improve aggregation efficiency. Extensive experiments demonstrate that the proposed method can effectively improve performance and outperform the state-of-the-art methods significantly.

A Novel Method for Food Market Regulation by Emotional Tendencies Predictions from Food Reviews Based on Blockchain and SAEs.

As a part of food safety research, researches on food transactions safety has attracted increasing attention recently. Food choice is an important factor affecting food transactions safety: It can reflect consumer preferences and provide a basis for market regulation. Therefore, this paper proposes a food market regulation method based on blockchain and a deep learning model: Stacked autoencoders (SAEs). Blockchain is used to ensure the fairness of transactions and achieve transparency within the transaction process, thereby reducing the complexity of the trading environment. In order to enhance the usability, relevant Web pages have been developed to make it more friendly and conduct a security analysis for using blockchain. Consumers' reviews after the transactions are finished can be used to train SAEs in order to perform emotional tendencies predictions. Compared with different advanced models for predictions, the test results show that SAEs have a better performance. Furthermore, in order to provide a basis for the formulation of regulation strategies and its related policies, case studies of different traders and commodities have also been conducted, proving the effectiveness of the proposed method.

Deletion of SarX Decreases Biofilm Formation of Staphylococcus aureus in a Polysaccharide Intercellular Adhesin (PIA)-Dependent Manner by Downregulating spa.

INTRODUCTION: Biofilm formation by Staphylococcus aureus is an important virulence determinant mediated by the polysaccharide intercellular adhesin (PIA) encoded by the ica operon or mediated by surface and extracellular proteins. SarX is a 250-residue two-domain SarA homolog that activates spa transcription. Previous studies demonstrated that Staphylococcus epidermidis SarX protein regulated the transcriptional activity of the agr and ica loci and controlled the biofilm phenotype, primarily by regulating icaADBC transcription and PIA production. RESULTS: In this study, biofilm formation and detachment of the clinical isolate S. aureus SA75 were significantly decreased in the sarX mutant strain. The effect of sarX mutation on S. aureus biofilm formation was related to the production of PIA and not to that of eDNA. Deletion of sarX was associated with a 1.8-fold reduction in spa transcription as determined by RT-PCR analysis, and this reduction could be restored by chromosomal complementation of sarX. Expression of Spa protein was also decreased in the S. aureus sarX mutant. CONCLUSION: sarX promoted biofilm production of S. aureus that may primarily be mediated through increasing ica operon expression and PIA production. Furthermore, deletion of sarX reduced S. aureus biofilm formation by downregulating spa.

A Novel Visual Analysis Method of Food Safety Risk Traceability Based on Blockchain.

Current food traceability systems have a number of problems, such as data being easily tampered with and a lack of effective methods to intuitively analyze the causes of risks. Therefore, a novel method has been proposed that combines blockchain technology with visualization technology, which uses Hyperledger to build an information storage platform. Features such as distribution and tamper-resistance can guarantee the authenticity and validity of data. A data structure model is designed to implement the data storage of the blockchain. The food safety risks of unqualified detection data can be quantitatively analyzed, and a food safety risk assessment model is established according to failure rate and qualification deviation. Risk analysis used visual techniques, such as heat maps, to show the areas where unqualified products appeared, with a migration map and a force-directed graph used to trace these products. Moreover, the food sampling data were used as the experimental data set to test the validity of the method. Instead of difficult-to-understand and highly specialized food data sets, such as elements in food, food sampling data for the entire year of 2016 was used to analyze the risks of food incidents. A case study using aquatic products as an example was explored, where the results showed the risks intuitively. Furthermore, by analyzing the reasons and traceability processes effectively, it can be proven that the proposed method provides a basis to formulate a regulatory strategy for regions with risks.

Prevalence of Community-Acquired, Hypervirulent Klebsiella pneumoniae Isolates in Wenzhou, China.

Hypervirulent Klebsiella pneumoniae (hvKP) can cause severe invasive infections in healthy and immunocompromised individuals. It is an important clinical pathogen, with the recent identification of highly invasive community-acquired K. pneumoniae that produce purulent liver abscess. Herein, the frequency, clinical characteristics, and molecular epidemiology of K. pneumoniae isolates obtained from January to October 2016 in Wenzhou, China, were examined. In the present study, 33 isolates (68.8%, 33/48) had a positive string test and were identified as hvKP. Both age and sex were associated with a positive string test (p < 0.05). Univariate analysis revealed that liver abscess (odds ratio = 10.154) was a significant risk factor for hvKP. Among the hvKP isolates, K1 was the most common capsular serotype, followed by K2 (p < 0.05). The prevalence of K1 and K2 was significantly higher in hvKP than non-hvKP isolates. The rates of virulence-associated genes, rmpA, iroB, fib, and hib, were significantly higher for hvKP than for non-hvKP (p < 0.05). In this study, kfuB, ybtA, and wcaG were associated with K1 isolates. ST23 was the predominant hvKP type, which belonged to serotype K1. Pulsed-field gel electrophoresis showed that two clusters had >75% similarity and each accounted for >3 isolates. The homology of the 48 clinical isolates was diverse. In conclusion, hvKP isolates had a high frequency of virulence factors and a wide variety of homologs. These results suggest that, because of the toxicity associated with K. pneumoniae, increased clinical understanding of the disease is important to prevent larger, severe outbreaks.

Fermionic spin excitations in two- and three-dimensional antiferromagnets.

Spin excitations in an ordered Heisenberg magnet are magnons-bosons with spin 1. That may change when frustration and quantum fluctuations suppress the order and restore the spin-rotation symmetry. We show that spin excitations in the S=1/2 Heisenberg antiferromagnet on a kagome lattice are spinons-fermions with spin 1/2. In the ground state the system can be described as a collection of small, heavy pairs of spinons with spin 0. A magnetic excitation of lowest energy amounts to breaking up a pair into two spinons at a cost of 0.06 J.

Outbreak of blaNDM-5-Harboring Klebsiella pneumoniae ST290 in a Tertiary Hospital in China.

The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) has posed a great threat to public health. Among 133 nonduplicated CRKP isolates collected between September 2016 and November 2017 in a tertiary hospital in China, 89 (89/133, 66.9%) and 31 (31/133, 23.3%) were positive for blaNDM-5 and blaKPC-2. Multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) revealed that ST290 represented the majority of NDM-5 producers (67/89, 75.3%) and PFGE cluster E accounted for 50 (50/67, 74.6%) ST290 isolates from the burn ward, suggesting that K. pneumoniae ST290 clone carrying blaNDM-5 resulted in an outbreak in this hospital. Whole genome sequencing of the plasmid carrying blaNDM-5 showed that the resistance gene blaNDM-5 was located in a ∼49 kb multireplicon plasmid with a peculiar insertion of ISKpn19 of the IncX3-type plasmid. To the best of our knowledge, this is the first report of outbreak of K. pneumoniae ST290 clone carrying blaNDM-5.

Low prevalence of mupirocin resistance among Staphylococcus aureus clinical isolates from a Chinese tertiary hospital.

Between September 2013 and March 2016, 26 (1.95 %) of 1333 Staphylococcus aureus clinical isolates from a Chinese hospital were found to be resistant to mupirocin, including 18 (1.35 %) with high-level mupirocin resistance and 8 (0.6 %) with low-level mupirocin resistance. Among the 18 isolates with high-level mupirocin resistance, 17 were associated with plasmid-mediated mupA. Meanwhile, the 8 isolates with low-level mupirocin resistance were shown to have a V588F mutation in ileS. A total of 14 sequence types (STs) and 18 spa types were identified. All four isolates with t062 belonged to ST965. Three ST5-MRSA-SCCmec II were linked to t311, which was not previously reported. Furthermore, ST764-MRSA-SCCmec II-t002, exclusively found in Japan before, was identified in this study. In conclusion, we observed relatively low prevalence of mupirocin resistance among S. aureus with considerable heterogeneity in East China. Newly emerging MRSA clones with high-level mupirocin resistance should be of concern.

Credit Evaluation System Based on Blockchain for Multiple Stakeholders in the Food Supply Chain.

The food supply chain is a complex system that involves a multitude of "stakeholders" such as farmers, production factories, distributors, retailers and consumers. "Information asymmetry" between stakeholders is one of the major factors that lead to food fraud. Some current researches have shown that applying blockchain can help ensure food safety. However, they tend to study the traceability of food but not its supervision. This paper provides a blockchain-based credit evaluation system to strengthen the effectiveness of supervision and management in the food supply chain. The system gathers credit evaluation text from traders by smart contracts on the blockchain. Then the gathered text is analyzed directly by a deep learning network named Long Short Term Memory (LSTM). Finally traders' credit results are used as a reference for the supervision and management of regulators. By applying blockchain, traders can be held accountable for their actions in the process of transaction and credit evaluation. Regulators can gather more reliable, authentic and sufficient information about traders. The results of experiments show that adopting LSTM results in better performance than traditional machine learning methods such as Support Vector Machine (SVM) and Navie Bayes (NB) to analyze the credit evaluation text. The system provides a friendly interface for the convenience of users.

Subinhibitory concentrations of resveratrol reduce alpha-hemolysin production in Staphylococcus aureus isolates by downregulating saeRS.

Resveratrol is a natural phytoalexin. In recent studies, it has been shown to have beneficial effects on cardiovascular disease and cancer and has been deemed to have effective antiviral and immunomodulatory activities. Methicillin-resistant Staphylococcus aureus is a multidrug-resistant pathogen associated with skin and soft tissue infections. Alpha-hemolysin is known to play a key role in the symptoms caused by S. aureus, and the saeRS two-component system has been shown to be a major regulatory system of S. aureus virulence. The present study was designed to determine the effect of subinhibitory concentrations of resveratrol on the production of alpha-hemolysin in S. aureus. The effect of resveratrol on the transcription of S. aureus was studied by transcriptome sequencing. A total of 760 genes with >2-fold changes in expression were selected, including 479 upregulated genes and 281 downregulated genes. On the basis of transcriptome sequencing, the expression of alpha-hemolysin in the S. aureus strains of the resveratrol-treated group was downregulated. Our results showed that resveratrol weakly inhibited the growth of S. aureus strains, and subinhibitory concentration of resveratrol decreased the expression of hla and inhibited the regulation of saeRS. Hemolysis testing confirmed that resveratrol had an inhibitory effect on the hemolysis of rabbit erythrocytes infected with S. aureus strains in a dose-dependent manner. Resveratrol also decreased the hemolytic capacity by reducing the production of alpha-hemolysin. We found that resveratrol could decrease the expression of hla and reduce the secretion of alpha-hemolysin by downregulating saeRS. These findings have provided more evidence of the potential of resveratrol as a drug for resisting S. aureus infections.

Sub-Inhibitory Concentrations of Mupirocin Strongly Inhibit Alpha-Toxin Production in High-Level Mupirocin-Resistant MRSA by Down-Regulating agr, saeRS, and sarA.

Mupirocin, a topical antibiotic, has been utilized for decades to treat Staphylococcus aureus skin infections, as well as to decolonize patients at risk of methicillin-resistant S. aureus (MRSA) infection. The aims of this study were to investigate the expression of α-toxin (encoded by the hla gene) in ten clinical MRSA strains (MIC = 1024 µg/ml) in response to a sub-inhibitory concentration of mupirocin (1/32 minimum inhibitory concentration [MIC]) (32 µg/ml) by using α-toxin activity determination and enzyme-linked immune sorbent assay (ELISA). Subsequently, real-time polymerase chain reaction (RT-PCR) was used to examine the expression of saeR, agrA, RNAIII, and sarA genes under sub-inhibitory concentration of mupirocin in order to investigate the mechanism of action of this treatment regarding its strong inhibition of α-toxin expression. For all the strains tested, mupirocin dramatically reduced mRNA levels of α-toxin. The results indicated that α-toxin activity in mupirocin-treated groups was significantly lower than that in untreated groups. The results show that the levels of agrA, RNAIII, saeR, and sarA expression significantly decrease by 11.82- to 2.23-fold (P < 0.01). Moreover, we speculate that mupirocin-induced inhibition of α-toxin expression may be related to the inhibition of regulatory loci, such as agr, sarA and saeRS. More specifically, we found that the mechanism involves inhibiting the expression of agrA and RNAIII. In conclusion, sub-inhibitory concentrations of mupirocin strongly inhibit alpha-toxin production in high-level mupirocin-resistant MRSA by down-regulating agr, saeRS and sarA, which could potentially be developed as a supplemental treatment to control high-level mupirocin-resistant MRSA infection and reduce the risk of infection and colonization.

Microbiological and Clinical Characteristics of Hypermucoviscous Klebsiella pneumoniae Isolates Associated with Invasive Infections in China.

A distinctive syndrome caused by hypermucoviscous Klebsiella pneumoniae (HMKP) including pyogenic liver abscess (PLA) is now becoming a globally emerging disease. In the present study, 22.8% (84/369) of K. pneumoniae clinical isolates associated with various types of invasive infections were identified as HMKP, with 45.2% associated with PLA. Multivariate regression analysis showed that male patients with 41-50 years, PLA, diabetes mellitus, and hypertension were independent risk factors for HMKP infections. K2 (42.9%, 36/84) was the most common capsular serotype among HMKP isolates, followed by K1 (23.8%, 20/84). Seventy-five percentage of K1 HMKP isolates were associated with PLA, while K2 HMKP isolates accounted for more types of invasive infections. The positive rates of iutA, mrkD, aerobactin, iroN, and rmpA among HMKP isolates were significantly higher than those among non-HMKP isolates (p < 0.05). There was a correlation between magA, ybtS, alls, and wcaG and K1 isolates. Interestingly, mrkD was exclusively detected among HMKP (32.1%, 27/84) and K2 isolates (65.9%, 27/41). All K1 and K2 HMKP and non-HMKP isolates were positive for rmpA. Aerobactin was found among 95.0 and 97.5% of K1 and K2 isolates. ST23 was found to be the most prevalent ST among 69 HMKP isolates with K1, K2, K5, K20, and K57 (27.5%, 19/69) and was only found among K1 isolates. ST65 was the second most prevalent ST (26.1%, 18/69) and was also only found among K2 isolates. ST23-K1 HMKP isolates (84.2%, 16/19) were associated with PLA, while ST65-K2 isolates were correlated with more types of infections relative to ST23-K1 isolates. PFGE results showed that the homology of 84 HMKP isolates was diverse. Only five PFGE clusters with more than 75% similarity accounted for more than three isolates. These five PFGE clusters only accounted for 35 (41.7%, 35/84) isolates. In conclusion, our study first found that hypertension and male patients with 41-50 years old were independent risk factors. The composition of ST types and PFGE clusters among K. pneumoniae K2 isolates was more diverse than K1 isolates. K1 and K2 HMKP isolates had respective specific profiles of virulence-associated genes.

SesI May Be Associated with the Invasiveness of Staphylococcus epidermidis.

Staphylococcus epidermidis is a commensal bacterium which widely colonizes in human skin and mucous membrane and rarely causes clinically manifested infections. S. epidermidis surface protein I (SesI) is considered to be the major virulence factor of S. epidermidis infection, but its pathogenesis is not clear. Here, we demonstrated that the prevalence of sesI among S. epidermidis invasive isolates (20.8%, 26/125) was significantly higher than that among colonizing isolates (3.8%, 4/106). The positive rates of biofilm-associated genes (aap, icaA, IS256) and resistance-associated genes mupA among the sesI-positive isolates were significantly higher than those among sesI-negative isolates (p < 0.05). And antimicrobial susceptibility testing showed that the resistance rates of sesI-positive isolates to ciprofloxacin, gentamicin and trimethoprim/sulfamethoxazole were significantly higher than those among sesI-negative isolates. Interestingly, 80.8% (21/26) of sesI-positive isolates belong to ST2 determined by MLST, while ST2 was not found among any of the 99 sesI-negative invasive isolates, indicating that there is a strong association between carriage of sesI and ST2 clone. In order to further study the role of sesI gene in pathogenesis, the sesI gene mutant (S. epidermidis RP62AΔsesI) and complementary expression strain (S. epidermidis RP62AΔsesI-C) were successfully constructed. All experimental data indicated that sesI may promote S. epidermidis to adhere and aggregate, but it had no obvious effect on the mature stage of biofilm formation. Taken together, these results suggest that sesI, along with antimicrobial and other biofilm-associated genes enables S. epidermidis easier for colonization and adhesion and contributes to the spread of S. epidermidis, especially ST2 clone.

Outbreak by Hypermucoviscous Klebsiella pneumoniae ST11 Isolates with Carbapenem Resistance in a Tertiary Hospital in China.

Hypervirulent and multidrug resistant Klebsiella pneumoniae strains pose a significant threat to the public health. In the present study, 21 carbapenem-resistant K. pneumoniae isolates (CRKP) were determined by the string test as hypermucoviscous K. pneumoniae (HMKP), with the prevalence of 15.0% (21/140) among CRKP, and 1.1% (21/1838) among all K. pneumoniae isolates. Among them, 7 (33.3%), and 1 (4.76%) isolate belonged to capsular serotype K20 and K2 respectively, while 13 (61.9%, 13/21) weren't successfully typed by capsular serotyping. All the 21 isolates were carbapenemase-producers and were positive for blaKPC-2. In addition to blaKPC-2, all the 21 isolates except one harbor blaSHV-11, and 15 carry extended-spectrum ß-lactamase gene blaCTX-M-65. The virulence-associated genes with more than 90% of positive rates among 21 isolates included ureA (100%, 21/21), wabG (100%, 21/21), fimH (95.2%, 20/21), entB (95.2%, 20/21), ycf (95.2%, 20/21), ybtS (95.2%, 20/21), and iutA (90.5%, 19/21). rmpA and aerobactin were found in 57.1% (12/21) isolates. Five sequence types (STs) were identified by multilocus sequence typing (MLST), including ST11 (11 K-non capsule typable and 5 K20 isolates), ST268 (1 K20 isolate and 1 K-non capsule typable isolate), ST65 (1 K2 isolate), ST692 (1 K-non capsule typable isolate), and ST595, a novel sequence type (1 K-non capsule typable isolate). Pulsed-field gel electrophoresis (PFGE) results showed two major PFGE clusters, of which cluster A accounts for 6 ST11 isolates (28.6%) and cluster B includes 8 ST11 isolates (38.1%, 8/21). Ten and six ST11 isolates were isolated from 2014 and 2015, respectively, while 8 were isolated from the same month of December in 2014. Ten isolates were collected from the intensive care unit (ICU), and all except one belonged to ST11. Additional 4 ST11 isolates were collected from patients in non-ICU wards, who had more than 10 days of ICU stay history in 2014 prior to transfer to their current wards where the isolates were recovered. Taken together, the present study showed a hospital outbreak and dissemination of ST11 HMKP with carbapenem resistance caused by KPC-2. Effective surveillance and strict infection control strategies should be implemented to prevent outbreak by HMKP with carbapenem resistance in hospitals.

Nematicity in stripe-ordered cuprates probed via resonant x-ray scattering.

In underdoped cuprate superconductors, a rich competition occurs between superconductivity and charge density wave (CDW) order. Whether rotational symmetry-breaking (nematicity) occurs intrinsically and generically or as a consequence of other orders is under debate. Here, we employ resonant x-ray scattering in stripe-ordered superconductors (La,M)2CuO4 to probe the relationship between electronic nematicity of the Cu 3d orbitals, structure of the (La,M)2O2 layers, and CDW order. We find distinct temperature dependences for the structure of the (La,M)2O2 layers and the electronic nematicity of the CuO2 planes, with only the latter being enhanced by the onset of CDW order. These results identify electronic nematicity as an order parameter that is distinct from a purely structural order parameter in underdoped striped cuprates.

A two-dimensional spin liquid in quantum kagome ice.

Actively sought since the turn of the century, two-dimensional quantum spin liquids (QSLs) are exotic phases of matter where magnetic moments remain disordered even at zero temperature. Despite ongoing searches, QSLs remain elusive, due to a lack of concrete knowledge of the microscopic mechanisms that inhibit magnetic order in materials. Here we study a model for a broad class of frustrated magnetic rare-earth pyrochlore materials called quantum spin ices. When subject to an external magnetic field along the [111] crystallographic direction, the resulting interactions contain a mix of geometric frustration and quantum fluctuations in decoupled two-dimensional kagome planes. Using quantum Monte Carlo simulations, we identify a set of interactions sufficient to promote a groundstate with no magnetic long-range order, and a gap to excitations, consistent with a Z2 spin liquid phase. This suggests an experimental procedure to search for two-dimensional QSLs within a class of pyrochlore quantum spin ice materials.