Streptococcus suis meningoencephalitis diagnosed with metagenomic next-generation sequencing: A case report with literature review.

Streptococcus suis is a pathogen of emerging zoonotic diseases and meningoencephalitis is the most frequent clinical symptom of S. suis infection in humans. Rapid diagnosis of S. suis meningoencephalitis is critical for the treatment of the disease. While the current routine microbiological tests including bacterial culture and gram staining are poorly sensitive, diagnosis of S. suis meningoencephalitis by metagenomic next-generation sequencing (mNGS) has been rarely reported. Here, we report a 52-year-old female pork food producer with a broken finger developed S. suis meningoencephalitis. After her admission, no pathogenic bacteria were detected through bacterial culture and Gram staining microscopy in the cerebrospinal fluid obtained via lumbar puncture. However, mNGS identified the presence of S. suis in the sample. mNGS is a promising diagnostic tool for rapid diagnosis of rare infectious diseases in the central nervous system.

Constituents from Chloranthus multistachys and their cytotoxic activities against various human cancer cell lines.

Two new furanoeremophilane sesquiterpenoids, namely, 6,9-dioxo-1α,4α-dihydroxy-furanoeremophilane (1) and 4α,5α-epoxy-6,9-dioxo-1α-hydroxyl-furanoeremophilane (2), and 10 known compounds were isolated from the whole plant of Chloranthus multistachys, and compound 3 was converted to derivative 3a. Their structures were determined based on extensive spectroscopic analysis. All compounds were evaluated by using five cancer cell lines: PC3, LNcap, A549, K562, and HEL. The derivative 3a exhibited excellent cytotoxic activities, with the IC50 against HEL cells being the lowest at 1.322 ± 0.08 µM, which was comparable to that of the positive control (doxorubicin). Mechanism studies showed that the anticancer activity of 3a may be associated with cell cycle regulation.

[Three new diterpenoids from whole herb of Carpesium cernuum].

The study investigated the chemical constituents from the whole herb of Carpesium cernuum. Three new diterpenoids were isolated from the whole herb of C. cernuum by column chromatography on silica gel, Sephadex LH-20, and semi-preparative HPLC. Their structures were identified by MS, NMR and other spectral techniques. The isolates were identified as(5Z)-2-oxo-2, 10, 14-trimethylhexadeca-5, 13-diene-11α, 18-diol(1),(2E, 10E)-7-[(acetyloxy)methyl]-3, 11, 15-trimethylhexadeca-2, 10, 14-triene-1, 12α-diol(2),(2E, 6Z)-3, 11, 15-trimethylhexadeca-2, 6, 14-triene-1, 12α, 19-triol(3), respectively. The cytotoxic activity of compounds 1-3 were investigated with DU-145, MCF-7, and A549 cells by MTT. The results showed that compound 1 and 3 had certain inhibitory effects on MCF-7 cells, with the inhibition rates of 45.06% and 29.40%, respectively.

The COVID-19 pandemic: Narratives of front-line nurses from Wuhan, China.

This study aimed to explore the experiences of nurses in Wuhan Hospital as front-line workers during the COVID-19 pandemic. A descriptive qualitative study of such nurses was conducted from a tertiary hospital in Wuhan. Semi-structured individual interviews were undertaken with 8 registered nurses who were front-line health workers in one of the COVID-19 wards and 3 nursing managers from the response team. Five discrete themes were identified from the narratives of nurses' experiences during the COVID-19 outbreak in Wuhan: "content of fundamental care," "teamwork," "reciprocity," "nurses' own worries," and "lifelong learning and insights." Nurses in the front line of care during the COVID-19 pandemic can contribute important information from their hands-on experience for providing a holistic response to an infectious outbreak like COVID-19. The concerns nurses raised at both personal and professional levels have implications for nursing education and clinical practice settings, particularly in the time of a pandemic when nurses' well-being requires attention, and at the same time for considering organizational factors that enable nurses to provide care to patients with confidence. Hospital policies and nursing management need to be ready and adhere to flexible work planning systems and approaches during a pandemic.

[Systematic review of external applications combined with three-step analgesic therapy in treating primary liver cancer pain].

To systemically evaluate the clinical efficacy and safety of traditional Chinese medicine( TCM) external application combined with three-step analgesic therapy in treating primary liver cancer pain. CNKI,Wanfang,CBM,VIP,Medline and Cochrane Library and manual retrieval were used to search for the clinical randomized controlled trials on TCM external applications combined with three-step analgesic therapy in treating primary liver cancer pain from database establishment to January,2018. The bias risk of RCTs was assessed by using the Cochrane system evaluator's Manual,and the extracted data were analyzed by using Review Manager 5. 3. Finally sixteen Chinese articles were enrolled,including one high quality article and 1 164 patients. Meta-analysis showed that TCM external applications combined with three-step analgesic therapy could alleviate the cancer pain( OR = 3. 44,95% CI[2. 49,4. 75],P <0. 000 01); prolong pain relief time( SMD = 3. 42,95%CI[1. 83,6. 40],Z = 3. 85,P = 0. 000 1); and improve the cartesian score of the patients( OR = 3. 42,95%CI[1. 83,6. 40],P = 0. 000 01). Descriptive analysis showed that the intervention may effectively shorten the onset time of pain relief,reduce VAS and NRS scores,reduce the dose of morphine,and reduce the number of bursts of pain. At present,the evidences have shown that the combination of TCM external applications combined with three-step analgesic therapy in treating primary liver cancer pain has superior clinical efficacy as compared with the three-step analgesic therapy alone. However,the clinical trials of existing small-sized randomized controlled trials have low quality of methodology and require a large sample of high quality clinical trials for further validation.

Multiple Silent Brain Infarcts Are Associated with Severer Stroke in Patients with First-Ever Ischemic Stroke without Advanced Leukoaraiosis.

BACKGROUND: Silent brain infarct (SBI) is associated with symptomatic stroke, but the association between SBI and acute ischemic stroke severity is uncertain. We aimed at investigating the association between SBI number and stroke severity in patients with first-ever ischemic stroke without advanced leukoaraiosis. METHODS: This study included 115 patients with first-ever ischemic stroke without advanced leukoaraiosis. National Institutes of Health Stroke Scale (NIHSS) scores were measured. Magnetic resonance imaging (MRI) was performed to detect the acute ischemic infarct and SBI. The location of infarct was divided into anterior and posterior circulations. The size of infarct was divided into large (≥15 mm) and small (<15 mm) infarctions. The number of SBIs was divided into single and multiple (r2) subgroups. The association between SBI and the NIHSS score was analyzed by stratification of stroke locations. The associations between SBI and the NIHSS score and the size of the acute ischemic infarct were analyzed by logistic regression. RESULTS: Of the 74 patients with SBI, single SBI was 30 (40.5%) and multiple SBIs were 44 (59.5%). Age (odds ratio [OR] = 1.125, P < .001) and hypertension (OR = 3.562, P < .05) were independent risk factors for SBI. When adjusted for all the other vascular risk factors, multiple SBIs had a higher percentage of more than 3 NIHSS scores (OR = 3.59, 95% confidence interval [CI]: 1.00-12.99, P = .048) and a large acute ischemic infarct (OR = 3.71, 95% CI: 1.23-11.22, P = .020) than no SBI. CONCLUSION: Multiple SBIs have severer neurological deficits and larger infarcts for ischemic stroke than no SBI, which may suggest the large-artery or cardiovascular vasculopathy evolution and poor collateral circulation in patients with multiple SBIs.

[Development and application of reference materials containing mixed degradation products of amoxicillin and ampicillin].

Reference materials containing mixed degradation products of amoxicillin and ampicillin were developed after optimization of preparation processes. The target impurities were obtained by controlled stress testing, and each major component was identified with HPLC-MS and compared with single traceable reference standard each. The developed reference materials were applied to system suitability test for verifying HPLC system performed in accordance with set forth in China Pharmacopeia and identification of major impurities in samples based on retention and spectra information, which have advantages over the methods put forth in foreign pharmacopoeias. The development and application of the reference materials offer an effective way for rapid identification of impurities in chromatograms, and provide references for analyzing source of impurities and evaluation of drug quality.

Performance of metagenomic next-generation sequencing in cerebrospinal fluid for diagnosis of tuberculous meningitis.

Purpose. Metagenomic next-generation sequencing (mNGS) has been widely used in the diagnosis of infectious diseases, while its performance in diagnosis of tuberculous meningitis (TBM) is incompletely characterized. The aim of this study was to assess the performance of mNGS in the diagnosis of TBM, and illustrate the sensitivity and specificity of different methods.Methods. We retrospectively recruited TBM patients between January 2021 and March 2023 to evaluate the performance of mNGS on cerebrospinal fluid (CSF) samples, in comparison with conventional microbiological testing, including culturing of Mycobacterium tuberculosis (MTB), acid-fast bacillus (AFB) stain, reverse transcription PCR and Xpert MTB/RIF.Results. Of the 40 enrolled, 34 participants were diagnosed with TBM, including 15(44.12 %) definite and 19(55.88 %) clinical diagnosis based upon clinical manifestations, CSF parameters, brain imaging, pathogen evidence and treatment response. The mNGS method identified sequences of Mycobacterium tuberculosis complex (MTBC) in 11 CSF samples. In patients with definite TBM, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of mNGS were 78.57, 100, 100, 66.67 and 85 %, respectively. Compared to conventional diagnostic methods, the sensitivity of mNGS (78.57 %) was higher than AFB (0 %), culturing (0 %), RT-PCR (60 %) and Xpert MTB/RIF (14.29 %).Conclusions. Our study indicates that mNGS of CSF exhibited an overall improved sensitivity over conventional diagnostic methods for TBM and can be considered a front-line CSF test.

Systemic and cerebrospinal fluid biomarkers for tuberculous meningitis identification and treatment monitoring.

IMPORTANCE: Tuberculous meningitis is a life-threatening infection with high mortality and disability rates. Current diagnostic methods using cerebrospinal fluid (CSF) samples have limited sensitivity and lack predictive biomarkers for evaluating prognosis. This study's findings reveal excessive activation of the immune response during tuberculous meningitis (TBM) infection. Notably, a strong negative correlation was observed between CSF levels of monokine induced by interferon-γ (MIG) and the CSF/blood glucose ratio in TBM patients. MIG also exhibited the highest area under the curve with high sensitivity and specificity. This study suggests that MIG may serve as a novel biomarker for differentiating TBM infection in CSF or serum, potentially leading to improved diagnostic accuracy and better patient outcomes.

[Application of combined fluorescence in situ hybridization and karyotype analysis for the diagnosis of Robertsonian translocation type trisomy 21].

OBJECTIVE: To assess the value of fluorescence in situ hybridization (FISH) combined with chromosomal analysis for the detection of Robertsonian translocation type trisomy 21 in amniotic fluid cells. METHODS: Amniotic fluid samples from pregnant women requesting prenatal diagnosis were cultivated. Metaphase cells were prepared for G-banding karyotype analysis. For the 5 Robertsonian translocation type trisomy 21, interphase nuclei from amniotic fluid and parental peripheral blood cells were prepared for FISH analysis. RESULTS: In 2 cases, analysis of parental peripheral blood cells showed normal karyotypes. FISH analysis of amniotic fluid cells indicated that one sample had two copies of chromosome 21, which has a 46, XY, rob(21;21)(q10;q10) karyotype, whilst another had trisomy 21 by FISH, which has a 46, XY, rob(14;21)(q10;q10) karyotype. For the remaining three samples, analysis of parental peripheral blood cells indicated that their karyotypes were 45, XX, rob(14;21)(q10;q10), 45, XX, rob(15;21)(q10;q10) and 45, XX, rob(21;22)(q10;q10), whilst the karyotypes of amniotic fluid cells were 46, XX, rob(14;21)(q10;q10), 46, XY, rob(15;21)(q10;q10) and 46, XX, rob(21;22)(q10;q10), respectively. CONCLUSION: Combined FISH and chromosomal analysis is an efficient method for detecting non-homologous Robertsonian translocation type trisomy 21. However, FISH has limited ability to detect homologous Robertsonian translocation type trisomy 21.

Distribution characteristics of non-point source pollution of TP and identification of key source areas in Nanyi Lake (China) Basin: based on InVEST model and source list method.

The Nanyi Lake basin, located in the middle and lower reaches of the Yangtze River, is a crucial component of the Yangtze River ecosystem. Excessive phosphorus levels lead to eutrophication in rivers and lakes. This study aims to enhance the identification efficiency of key source areas for non-point source pollution of total phosphorus (TP) in the Nanyi Lake Basin and improve decision-making regarding the treatment of these areas. The study employs the InVEST model and utilizes GIS spatial hot spot analysis to identify key source areas of agricultural TP non-point source pollution. The accuracy of the InVEST model's simulation results was verified using the source list method. The findings indicate that paddy fields serve as the primary pollution source. TP non-point source pollution in Nanyi Lake is influenced by pollution sources, pollution load filtration rate, and potential TP runoff mass concentration. Different pollution sources correspond to distinct key source areas, and the pollution generated by these sources in different administrative regions, ultimately affecting the lake, varies as well. The InVEST model demonstrates great applicability in regions where agricultural TP is the primary pollution source. For the Nanyi Lake basin, which predominantly experiences agricultural TP non-point source pollution, a combination of the InVEST model and the source list method is recommended. The InVEST model serves as the primary tool, while the source list method supplements it. This approach not only compensates for any limitations of the InVEST model's simulation results but also avoids unnecessary economic waste. The outcomes of this study contribute to a deeper scientific understanding of TP pollution in the Nanyi Lake Basin. They also aid in effectively identifying key source areas and formulating appropriate measures based on the pollution characteristics, thereby providing guidance for non-point source pollution control in the basin.

Comparison of perceived general health status between suspected and confirmed cases of COVID-19 and identifying the nursing diagnoses: A cross-sectional study.

AIM: This study aimed to examine the differences in health status between patients with confirmed COVID-19 and those suspected (other diagnosis) and to identify nursing diagnoses using a structured checklist from a hospital in China. DESIGN: Cross-sectional study design was used. METHODS: One hundred sixty COVID-19 confirmed, and suspected patients were conveniently selected. A structured survey and checklist were utilized. Independent t test and chi-square test were employed to compare the mean between patients with confirmed coronavirus infection and others. A two-sided p-value of .05 or less is considered statistically significant. RESULTS: The study yielded a response rate of 93.6%. The result indicated that patients with confirmed coronavirus infection have a higher proportion of perceived General Health Status than inpatients with suspected (other) diagnoses. The finding also indicated that ineffective airway clearance, hyperthermia, imbalanced nutrition less than body requirement and sleep pattern disturbance were the main nursing diagnoses identified.

High Prevalence of Carbapenem-Resistant Enterobacterales Colonization Among Intensive Care Unit Patients in a Tertiary Hospital, China.

Intestinal colonization with carbapenem-resistant Enterobacterales (CRE) has been shown as a significant risk factor for subsequent CRE infections, especially in intensive care units (ICUs). The aim of this study was to determine the prevalence of intestinal CRE colonization among ICU patients in a Chinese tertiary hospital. Fecal sample screenings for CRE were performed on ICU patients weekly. Antibiotic-susceptibility profile of CRE strains was determined using the Vitek-2 analysis system and broth microdilution method. The carbapenemases of all isolates were determined by phenotypes and genotypes. Clonal relatedness was analyzed by pulsed-field gel electrophoresis (PFGE). Whole-genome sequencing was used to identify the multilocus sequence type (ST), plasmid replicons, and insertion sequences (ISs) of isolates. The overall colonization rate of CRE was 40.4% (82/203). A total of 84 CRE strains were detected, mostly with Klebsiella pneumoniae (92.9%). Antibiotic susceptibility testing profile revealed that 84 CRE strains were resistant to most antibiotics except for tigecycline and colistin. The carbapenemase-encoding genes including blaKPC-2, blaNDM-1, and blaIMP-4 were detected, and blaKPC-2 was the predominant genotype (90.8%). A total of 9 STs were identified among 84 CRE strains, and ST11 was the most common type (83.3%). A variety of mobile genetic elements, including plasmids and ISs, were detected via online tool prediction. PFGE analysis of the 78 K. pneumoniae strains showed 8 different pulsotypes, and pulsotype A was highly prevalent. This study found that the prevalence of CRE colonization was alarmingly high in the ICU, and that effective infection control measures are urgently needed to prevent the dissemination of CRE.

Spatial heterogeneity of soil heavy metal content in Baiyinhua mining area, Inner Mongolia, China.

To evaluate the spatial distribution characteristics of soil heavy metal content in Xiwuzhumuqin Banner, Inner Mongolia, we analyzed the spatial heterogeneity of soil Cu, Cr, Pb, and Mn contents within 8 km distance of the mining area. Results showed that the contents of Cu, Cr, Pb and Mn in soil were 12.7, 32.6, 29.9 and 201.3 mg·kg-1, and their coefficients of variation were 26.8%, 33.9%, 27.1% and 45.7%, respectively. According to the model fitting by semi-variance function, the spatial distribution of Cu, Cr, Pb and Mn were consistent with the Gaussian model, Gaussian model, Gaussian model and linear model, respectively. Results of the spatial distribution pattern analysis showed that the spatial correlation levels of Mn, Cr and Cu were high, which were mainly affected by structural factors, but little affected by random factors. The spatial correlation level of Pb element was moderate, which was affected by both structural factors and random factors. Results of the fractal dimension analysis showed that the spatial distribution of four heavy metal contents was simple. Combined with 2D and 3D views, the four types of heavy metals all presented gradient distribution, which decreased with the increases of distance. The contents of Cu and Mn were mainly concentrated within 1.5 km from the mining area, while Cr and Pb were mainly concentrated within 2.0 km and 3.0 km from the mining area, respectively.

[Theory of selectivity of RP-LC C18 column and its application].

In recent years, more and more researchers focus on the selectivity of RP-HPLC columns. Among these columns, C18 column is the most commonly used the column. Yet even the same filler can not give us the same separation effect with the columns of different brands and different types, therefore, it is important to choose the suitable HPLC column for carrying out an experiment. After study in recent years, some column classification, selection methods (e.g.: column parameter method, F value method) have been achieved and contributed to the finding of suitable columns and reducing the blindness of column selection. This paper summarizes the advantages of these methods and their limitations in the application process, and gives some advice and expectations to pharmaceutical analysis works based on the works of other researchers.

[Composition and spatial distribution of main species in grassland community of Baiyinhua mining area, China]. / 白音华矿区草地群落主要物种组成及空间分布.

We analyzed composition and spatial distribution of main species in the surrounding grassland of Baiyinhua mining area in Inner Mongolia. The results showed that there were 55 plant species in the grassland, with dominant species being Stipa grandis, Carex korshinskyi, and Cleistogenes squarrosa, and common species being Leymus chinensis, Agropyron cristatum, and Anemarrhena asphodeloides. The accumulative relative importance value of those six species was 79.6%, with their densities being 26.6, 204.7, 105.4, 107.1, 68.2 and 55.1 individuals·m-2, respectively. The population density of those six species was modeled by the semi-variance function. The population distribution was in accordance with the exponential model, exponential model, exponential model, spherical model, linear model and Gaussian model, respectively. Through analyzing the spatial distribution pattern, structure ratios were 59.2%, 97.2%, 89.1%, 94.5%, 62.6% and 72.1%, respectively. The spatial autocorrelation of C. korshinskyi, C. squarrosa and L. chinensis populations was mainly affected by structural factors, whereas S. grandis, A. cristatum and A. asphodeloides were mainly affected by random factors. According to results from the fractal dimension analysis, population distribution patterns of S. grandis, C. korshinskyi, C. squarrosa and A. cristatum were simple, and the spatial dependence was strong. Both L. chinensis and A. asphodeloides showed contrasting patterns with those four species. From 2D and 3D images, S. grandis and A. asphodeloides showed gradient diffusion, while C. korshinskyi, C. squarrosa, L. chinensis and A. cristatum showed patch distribution. The results showed that the spatial distribution of the main species in this grassland community did not correlate with mining.

Significance of hemodynamic assessment by pressure wire for endovascular therapy of subclavian steal syndrome.

OBJECTIVE: Subclavian steal syndrome results from hemodynamic impairment due to stenosis or occlusion of subclavian artery. Therefore, it is important for subclavian steal syndrome patients to assess hemodynamic status during endovascular therapy. METHODS: Eleven subclavian steal syndrome patients undergoing endovascular therapy attended this study. Pressure wire was used to measure trans-stenosis pressure difference (ΔP). Digital subtraction angiography, Transcranial Doppler and Electronic sphygmomanometer were introduced to assess stenotic rate, steal grade and inter-arm systolic pressure difference, respectively. Clinical symptoms and restenosis were followed up after endovascular therapy. The associations of ΔP with stenotic rate, inter-arm pressure difference, steal degree, clinic symptoms and restenosis were analyzed in this paper. RESULTS: Prior to the therapy, ΔP moderately correlated with stenotic rate (r = 0.757, p = 0.007) and inter-arm pressure difference (r = 0.701, p = 0.016). ΔP was ≥6 mmHg in all patients, and 6-9 mmHg for grade 1 steal and ≥10 mmHg for grade 2 and 3 steals. After the therapy, all patients had technique success, and 10 patients had clinic success, and 1 patient appeared restenosis. ΔP was ≤3 mmHg and steal disappeared in the patients with clinical success. ΔP was 18 mmHg and grade 3 steal still existed in one patient without clinical success. One patient with 1 mmHg of ΔP after therapy appeared restenosis in the follow-up. CONCLUSION: The trans-stenosis pressure difference is closely related to steal degree and clinical symptoms. The measurement of hemodynamic status by pressure wire is very useful to guide endovascular therapy in subclavian steal syndrome patients. However, the restenosis may still occur, even though the hemodynamic impairment is improved.

Tirucallane-type triterpenoids from the fruits of Phellodendron chinense Schneid and their cytotoxic activities.

Eleven triterpenoids were isolated from the fruits of Phellodendron chinense Schneid, and their structures were determined by spectroscopic analysis. The results show that four new tirucallane-type triterpenoids 1, 2, 5, and 6 and seven known compounds 3, 4, 7, 8, 9, 10, and 11 were isolated. Structurally, compound 6 was uncommon; it has a chlorine atom instead of a methyl group at the C-20 position. The cytotoxicities of the compounds was evaluated against the in vitro proliferation of four human tumor cell lines HEL, K562, MDA, and PC3 using adriamycin as the positive control. Compound 1 showed a similar cytotoxicity as the positive control; compounds 3 and 10 showed moderate cytotoxicities compared to the control (P<0.05). This indicates that these compounds have great potential for the development of new antitumor drugs.

[The biotransformation of kaempferitrin by human intestinal flora].

AIM: To study the biotransformation of kaempferitrin, a major chemical principle of the fruits of Siraitia grosvenori (Swingle) C. Jeffery, with human intestinal flora. METHODS: The kaempferitrin was incubated with human intestinal flora. The biotransformation products were isolated and purified by chromatographic methods and the structures were determined by spectroscopic techniques. RESULTS: Kaempferitrin was converted into kaempferol 3-O-alpha-L-rhamnoside (afzelin, I) , kaempferol 7-O-alpha-L-rhamnoside (II), kaempferol (III) and p-hydroxybenzoic acid (IV) by human intestinal flora. rhamnoside (II), kaempferol (III) and p-hydroxybenzoic acid (IV) by human intestinal flora. CONCLUSION: The structure of kaempferitrin can be biotransformatedly converted by human intestinal flora.

The selection of suitable columns for a reversed-phase liquid chromatographic separation of beta-lactam antibiotics and related substances via chromatographic column parameters.

The selection of RP-LC columns suitable for a particular analysis in official compendia is difficult as only a general description of the stationary phase in the description of a LC method is given. General methods to characterize RP-LC columns often assume that each of the column parameters is equally important. This can cause the user to select columns inappropriate for particular analyses. This paper focuses on the relationship between the critical peak pairs and the column parameters (H, S, A, B, and C) in the Snyder/Dolan column characterization methodology to find the key parameters influencing real separations. Some varieties of ß-lactam antibiotics and their related compounds were used as test compounds. We found column parameter A to be the most important factor affecting their separation. Parameters B and C also played an important role in some separation processes. This indicated that the hydrogen bonding of column and solute can directly affect the separation of ß-lactam antibiotics. Choosing columns for which column parameter A is near 0.1 can facilitate the ideal separations of impurities from ß-lactam antibiotics. The most suitable column for any common pharmaceutical analysis could be selected easily if the key column parameters would be given in the description of the chromatographic method. For these reasons, key column parameters should be listed in the monographs of official compendia.