Antibiotics De-Escalation in the Treatment of Ventilator-Associated Pneumonia in Trauma Patients: A Retrospective Study on Propensity Score Matching Method / 中华医学杂志(英文版)

<p><b>Background</b>Antimicrobial de-escalation refers to starting the antimicrobial treatment with broad-spectrum antibiotics, followed by narrowing the drug spectrum according to culture results. The present study evaluated the effect of de-escalation on ventilator-associated pneumonia (VAP) in trauma patients.</p><p><b>Methods</b>This retrospective study was conducted on trauma patients with VAP, who received de-escalation therapy (de-escalation group) or non-de-escalation therapy (non-de-escalation group). Propensity score matching method was used to balance the baseline characteristics between both groups. The 28-day mortality, length of hospitalization and Intensive Care Unit stay, and expense of antibiotics and hospitalization between both groups were compared. Multivariable analysis explored the factors that influenced the 28-day mortality and implementation of de-escalation.</p><p><b>Results</b>Among the 156 patients, 62 patients received de-escalation therapy and 94 patients received non-de-escalation therapy. No significant difference was observed in 28-day mortality between both groups (28.6% vs. 23.8%, P = 0.620). The duration of antibiotics treatment in the de-escalation group was shorter than that in the non-de-escalation group (11 [8-13] vs. 14 [8-19] days, P = 0.045). The expenses of antibiotics and hospitalization in de-escalation group were significantly lower than that in the non-de-escalation group (6430 ± 2730 vs. 7618 ± 2568 RMB Yuan, P = 0.043 and 19,173 ± 16,861 vs. 24,184 ± 12,039 RMB Yuan, P = 0.024, respectively). Multivariate analysis showed that high Acute Physiology and Chronic Health Evaluation II (APACHE II) score, high injury severity score, multi-drug resistant (MDR) infection, and inappropriate initial antibiotics were associated with patients' 28-day mortality, while high APACHE II score, MDR infection and inappropriate initial antibiotics were independent factors that prevented the implementation of de-escalation.</p><p><b>Conclusions</b>De-escalation strategy in the treatment of trauma patients with VAP could reduce the duration of antibiotics treatments and expense of hospitalization, without increasing the 28-day mortality and MDR infection.</p>

Enterogenous infection of Candida albicans in immunocompromised rats under severe acute pancreatitis / 世界急诊医学杂志（英文）

@#BACKGROUND: Opportunistic infection of Candida albicans (C. albicans) has become a serious problem in immunocompromised patients. The study aimed to explore the mechanism of enterogenous infection of C. albicans in immunocompromised rats under severe acute pancreatitis (SAP). METHODS: Sprague Dawley (SD) rats (n=100) were randomly assigned into 5 groups as the following: blank group, cyclophosphamide+ceftriaxone+SAP group, cyclophosphamide+ceftriaxone group, cyclophosphamide+SAP group, and cyclophosphamide group. The rats were sacrificed at 5 and 10 days, and their jejunum, colon, mesenteric lymph nodes, pancreas, intestinal content, and blood were quickly collected to detect C. albicans. A region of the 25S rRNA gene was chosen and amplified by polymerase chain reaction (PCR) to differentiate C. albicans genotypes. The amplified products were further sequenced and compared to judge their homology. RESULTS: Compared with the Cyclophosphamide group, the combination of immunosuppressants and broad-spectrum antibiotics significantly increased the colonization of C. albicans in intestine in 5 and 10 days. Pure SAP stress did not increase the opportunistic infection of C. albicans. The PCR products of C. albicans isolates all belonged to the genotype A family, and sequence alignment showed that the amplified fragments were homologous. CONCLUSION: The damage of immune system and broad-spectrum antimicrobial agents are important risk factors for opportunistic fungal infection. Intestinal tract is an important source for genotype-A C. albicans to translocate and invade into bloodstream.

Effect of Candida albicans on Intestinal Ischemia-reperfusion Injury in Rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Inflammation is supposed to play a key role in the pathophysiological processes of intestinal ischemia-reperfusion injury (IIRI), and Candida albicans in human gut commonly elevates inflammatory cytokines in intestinal mucosa. This study aimed to explore the effect of C. albicans on IIRI.</p><p><b>METHODS</b>Fifty female Wistar rats were divided into five groups according to the status of C. albicans infection and IIRI operation: group blank and sham; group blank and IIRI; group cefoperazone plus IIRI; group C. albicans plus cefoperazone and IIRI (CCI); and group C. albicans plus cefoperazone and sham. The levels of inflammatory factors tumor necrosis factor (TNF)-μ, interleukin (IL)-6, IL-1β, and diamine oxidase (DAO) measured by enzyme-linked immunosorbent assay were used to evaluate the inflammation reactivity as well as the integrity of small intestine. Histological scores were used to assess the mucosal damage, and the C. albicans blood translocation was detected to judge the permeability of intestinal mucosal barrier.</p><p><b>RESULTS</b>The levels of inflammatory factors TNF-μ, IL-6, and IL-1β in serum and intestine were higher in rats undergone both C. albicans infection and IIRI operation compared with rats in other groups. The levels of DAO (serum: 44.13 ± 4.30 pg/ml, intestine: 346.21 ± 37.03 pg/g) and Chiu scores (3.41 ± 1.09) which reflected intestinal mucosal disruption were highest in group CCI after the operation. The number of C. albicans translocated into blood was most in group CCI ([33.80 ± 6.60] ×102 colony forming unit (CFU)/ml).</p><p><b>CONCLUSION</b>Intestinal C. albicans infection worsened the IIRI-induced disruption of intestinal mucosal barrier and facilitated the subsequent C. albicans translocation and dissemination.</p>

Detection of F1 antibody against Yersinia pestis in flushing fluid of heart blood of Rhombomys opimus with ELISA: a feasibility study / 中国地方病学杂志

Objective To analyse the feasibility of detecting F1 antibody to Yersinia pestis in flushing fluid of heart blood of Rhombomys opimus with enzyme linked immunosorbent assay(ELISA) method and its application value in surveillance of the disease. Methods Serum, flushing fluid of heart blood and infusion fluid of liver and spleen of Rhombomys opimus, which were caught by capture in the plague focus of Zunger basin in 2007, were taken to carry out detection for F1 antibodies to Yersinia pestis with ELISA method. The data were processed with SPSS 17.0. Results Positive rate and average titer of serum were 12.35%(11/162) and 25.35, of flushing fluid of heart blood were 10.49%(17/162) and 23.75 and of the infusion fluid of liver and spleen 6.79%(17/162) and 2240,respectively. No statistical difference was found in positive detection rate when it was compared between serum and flushing fluid of heart blood(χ2 = 1.333, P ＞ 0.05), but it was obviously different between serum and infusion fluid of liver and spleen(χ2 = 7.111, P ＜ 0.01 ) and between flushing fluid of heart blood and infusion fluid of liver and spleen(x2 = 6.250, P ＜ 0.05). There was a significant difference in average titer between serum, flushing fluid of heart blood and infusion fluid of liver and spleen(t = 2.290, 3.612, P ＜ 0.05 or ＜ 0.01 ). The plague F1 antibody positive coincidence rate of serum and flushing fluid of heart blood was 85.0%(17/20), of serum and infusion fluid of liver and spleen was 55.0% (11/20), and of flushing fluid of heart blood and infusion fluid of liver and spleen was 64.7%(11/17). Conclusions The ELISA method can detect Fl antibody in flushing fluid of heart blood,and the method is feasible in plague surveillance.

Comparison of three immunological methods in detection of Yersina pestis F1 antigen / 中国地方病学杂志

Objective To compare the effect of three methods in diagnosis of plague by detecting of Yersina pestis F1 antigen. Methods In natural foci of plague, wild animal samples, such as blood, liver, spleen,and lymphoid tissue were collected, and the three methods of enzyme linked immunosorbent assay (ELISA),reverse indirect hemagglutination assay(RIHA) and gold-immunochromatography assay(GICA) were employed to detect F1 antigen of Yersina pestis. Results Total of 414 infused organ samples of natural death and captured wild animals in natural foci of plague were determined. Positive samples detected by GICA and ELISA were the same,the positive rates were 5.31%(22/414), both positive and negative coincidence rates were consistently 100%. Only 18 samples were positive by retrial in 186 samples with more than 2 holes aggregation by preliminary examination of RIHA, with nonspecific agglutination rate of 40.6% (168/414) and positive rate of 4.35% (18/414). The positive coincidence rate was 81.82% (18/22) between RIHA with GICA and ELISA, and negative coincidence rate was statistically significant(t = 4.379, P ＜ 0.01). Conclusions ELISA, RIHA and GICA can be used for early diagnosis of plague by detecting F1 antigen. The results of RIHA have quantitative significance, with higher non-specific agglutination rate, and heavy workload of re-examination; GICA and ELISA has the same specificity and sensitivity, but the results of GICA is only qualitative. ELISA excluded the defect of RIHA and GICA, and combines the advantages of both methods.

Fibrotic remodeling of nasal mucosa in rat model after radiation injury / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the role of nasal mucosa fibrosis on radiation induced nasal mucosa injury.</p><p><b>METHODS</b>Seventy two male rats were randomly divided into two groups, control group and irradiation injured group (radiation dose were 40 Gy); the rats were killed 1 week, 2 weeks, 4 weeks, 8 weeks, 3 months and 6 months after the finish of radiation. The middle turbinates of the animals were removed. The pathological change of the nasal mucosa were observed with scanning electron microscope, transmission electron microscope, hematoxylin and eosin (HE), alcian blue-periodic acid-Schif (AB-PAS), and Masson Trichrome (MT). The Hyp content in nasal mucosa was measured with chemo-chromatometry.</p><p><b>RESULTS</b>After radiation, the pathological characteristics in early stage (within 4 weeks) was acute inflammatory reaction. The repair of nasal mucosa started 4 weeks after radiation, lasted to 6 months. The deposition of collagen in nasal mucosa could be found 1 week after irradiation and increased gradually.</p><p><b>CONCLUSION</b>Irradiation could induce a serials of pathological changes on nasal mucosa. The nasal mucosa fibrosis may be one of the reasons of persistent irradiation induced nasal mucosa injury.</p>

Study on the situation of plague in Junggar Basin of China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the distribution, fauna, population structure of host animals and their parasitic fleas as well as popular dynamic of animal plague of natural plague foci in Junggar Basin.</p><p><b>METHODS</b>Sample materials and data of animals and vector insects were collected using ecological methods and the population structures were analyzed statistically. F1 antibody of Yersinia pestis in rodents' serum and organ suspension was detected by means of IHA while the pathogen of Y. pestis in rodents and vector insects was detected by means of aetiological detections and the isolated Y. pestis was detected using biochemical methods.</p><p><b>RESULTS</b>The small mammals which were found in Junggar Basin belonged to 17 species of 11 genera 7 families. Of them, 13 species of rodents were included whose parasitic fleas belonged to 19 species of 10 genera 8 families. The average coverage of Rhombomys opimus hole-community was 22.5% in Junggar Basin with the average density of R. opimus hole-community was 15.9/hm2 and the average rate of habitat of the hole-community was 70.2%. In the R. opimus community, the average density of rodents was 3.1/hole-community, and 34.4/hm2 in the nature plague foci. In the population structure of the hole-community of R. opimus, R. opimus accounted for 72.9% in the total captured rodents, Meriones meridianus was 24.5% while the others were 2.6%. In the nocturnal community of rodents, M. meridianus accounted for 64.0% in total captured rodents, Dipus sagitta was 15.1%, M. erythrourns was 7.5% and the others were 13.4%. In the rodents community of Junggar Basin, the rate of R. opimus with fleas was 84.9%, which was the highest, followed by M. tamariscinus, Euchoreutes naso and M. erythrourns, with the rates as 71.4%, 66.7% and 62.7% respectively. The rate of M. meridianus with fleas was 38.3%. There were 16 species of parasitic fleas in R. opimus, with the total flea index as 8.58 and the dominant species was Xenopsylla skrjabini. There were 17 and 16 kinds of fleas in M. erythrourns and M. meridianus respectively with the total flea index were 1.59 and 1.15, with dominant fleas were Nosopsyllus laeviceps and X. skrjabini. The serum and organ suspension of 3179 rodents which belonged to 12 species were detected by means of IHA, of them 174 samples were positive and the positive rate was 5.5%. There were 1356 samples of R. opimus in these materials, and 164 were positive, accounted for 12.1%. The samples of M. meridianus were 1255, with 9 positive, accounted for 0.7%. The samples of D. sagitta were 116 with 1 positive and the rate was 0.9%. The samples of other rodents were 452 but were all negative. There were in total 2975 organs collected from rodents, when detected by methods of isolated of Y. pestis. 15 strains of Y. pestis were isolated from 1243 R. opimus, and 2 strains isolated from 1230 M. meridianus. A total number of 11 647 fleas from rodents were detected by methods of isolated of Y. pestis in which 1 strain of Y. pestis was isolated from 4713 X. skrjabini, and 6 were isolated from 2101 Xenopsylla minax, 1 from 328 Xenopsylla conformis conformis and 1 from 250 Echidnophaga oschanini. Among the other 4255 fleas, none was isolated. The biochemical properties of these Y. pestis which isolated from Junggar Basin were positive of Maltose, Ejiao sugar and Glycerol, and negative of Rhamnose and Nitrogen, which were all strongly poisonous to mouse.</p><p><b>CONCLUSION</b>The natural plague foci in Junggar Basin spread all over the whole Junggar Basin. There were animal plague cases found in 12 counties (cites) while Karamy, Bole, Jimusaer and Qitai were confirmed as plague foci counties (cities). Animals and vector insects of the foci were complicated but the ecological system was stable. R. opimus was recognized as the dominant host animal and its biochemical type belonged to the Middle Ages, suggesting that the foci was a new type of natural plague foci.</p>

The 30 cases clinical analysis of nasal cavity and paranasal sinuses by endoscopic sinus surgery / 中国基层医药

Objective To explore the effect of endoscopic sinus surgery on inverted papilloma of nasal cavity and paranasal sinuses in 30 cases.Methods 30 patients with inverted papilloma of nasal cavity and paranasal sinuses were operated on by endoscopic sinus surgery.Results During a follow-up of 2～3 years,only four cases recurred, Conclusion Endoscopic sinus surgery had advantsges of clear field and little injury,and therefore it was effective for inverted papilloma of nasal cavity and paranasal sinuses.

Overexpression and detection of the mutated glucose isomerase GIG138P and GIG138P-G247D in Streptomyces lividans / 生物工程学报

The shuttle expression vectors pHZGI1 and pHZGI2 were successfully constructed by inserting structural genes of GI containing single mutated site G138P and double mutated site G138P-G247D into E. coli-Streptomyces shuttle vector pHZ-1272, respectively. Then they were transformed into S. lividans TK54 strain by protoplast transformation. SDS-PAGE indicated that two shuttle vectors in TK54 strain expressed obviously specific bands at 42.5 kD after inducted by 2 micrograms/mL thiostrepton. Optical densitometric scan showed that the content of the mutant enzymes GIG138P and GIG138P-G247D were about 19% and 22% of dissoluble proteins, respectively. Western blotting farther proved that GIG138P and GIG138P-G247D were expressed in S. lividans TK54.

Effect of acute hypervolemic hemodilution on pharmacokinetics of propofol in patients undergoing total hip replacement / 中华麻醉学杂志

Objective To investigate the influence of acute hypervolemic hemodilution(HHD)on pharmacokinetics of propofol.Methods Sixteen ASA Ⅰ or Ⅱ patients aged 20-55 yrs undergoing elective surgery under general anesthesia combined with epidural analgesia were randomly allocated into 2 groups(n=8 each);Ⅰ control group and Ⅱ HHD group.The patients were premedicated with intramuscular phenobarbital 0.1 g and scopolamine 0.3 mg.Right internal jugular vein was cannulated for CVP monitoring and blood sampling.Radial artery was cannulated for BP monitoring.All patients in both groups received lactated Ringer's solution(0.7 ml?kg~(-1)? number of hours of fasting before operation)before induction of general anesthesia.In HHD group 4% gelofusine 20 ml?kg~(-1) was infused at the rate of 20 ml?kg~(-1)?h~(-1).Anesthesia was induced with midazolam 0.04 mg?kg~(-1),fentanyl 4 ?g?kg~(-1) and propofol 1.5 mg?kg~(-1).Tracheal intubation was facilitated by succinylcholine 2 mg?kg~(-1).Anesthesia was maintained with isoflurane,fentanyl,vecuronium and epidural analgesia.ECG,BP, SpO_2,P_(ET)CO_2 and CVP were continuously monitored.Blood samples were taken at 1,2,4,6,10,15,30,45, 60,75,90,120,150,180,240,300 and 360 min after propofol was given Ⅳ for determination of plasma concentration of propofol(HPLC).Pharmacokinetic data were analyzed by 3P97 pharmacokinetic software.Results The two groups were comparable with respect to demographic data.Blood propofol concentrations were significantly lower in HHD group than in control group at 1,2,4,6,10 min after propofol injection(P＜0.01), thereafter there was no significant difference in plasma propofol concentration between the two groups(P＞0.05). The pharmacokinetic profile of propofol was well described by a standard three-compartment model.In HHD group V_C was significantly increased,K_(10) and Cl were significantly decreased and T_(1/2?) was significantly prolonged as compared with control group.Conclusion Acute HHD increases V_C,prolongs the T_(1/2?) and decreases K_(10) and Cl, suggesting that the effect of propofol may be potentiated by acute HHD.