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Objective:To evaluate the clinical performance of direct antimicrobial susceptibility test in blood culture-positive broth, and to provide a basis for optimizing the antibiotic use strategy in clinical bloodstream infection.Methods:A retrospective analysis was conducted on 780 blood culture-positive samples collected in Peking University People′s Hospital from May 2017 to December 2021. The direct antimicrobial susceptibility test was performed by disk diffusion method on blood culture-positive broth. The antimicrobial susceptibility breakpoints were in accordance with Clinical and Laboratory Standards Institute (CLSI) M100 S32 edition document.Results:In this study, a total of 331 strains of Gram-negative bacteria (139 strains of Escherichia coli, 79 strains of Klebsiella pneumoniae, 35 strains of Pseudomonas aeruginosa, 21 strains of Acinetobacter baumannii) and 396 strains of Gram-positive cocci (25 strains of Staphylococcus aureus, 316 strains of coagulase-negative staphylococci, 47 strains of Enterococcussp.) were collected, after excluding 53 cases with two or more isolates. Compared with the routine antimicrobial susceptibility test (AST), the rates of category agreement (CA), major error (ME), and very major error (VME) of Gram-negative bacteria were 86.0% (1368/1 591), 8.7% (139/1 591), and 0.5% (8/1 591), respectively. On the other hand, the CA%, ME%, and VME% of Gram-positive cocci were 89.2% (960/1 076), 7.5% (81/1 076), and 1% (11/1 076), respectively. Regarding the individual antimicrobial agents, the CA% of Escherichia coli was 16/17 for imipenem, 90.1% (109/121) for meropenem, and 70.8% (85/120) for cefepime. For Klebsiella pneumoniae, the CA% of was 10/13 for imipenem, 80.9% (55/68) for meropenem, and 80.3% (53/66) for cefepime. The CA% of meropenem in Pseudomonas aeruginosa and Acinetobacter baumannii were 96.0% (24/25) and 16/16. The CA% of linezolid and cefoxitin in Staphylococcus aureus were 100% (25/25) and 100% (24/24), respectively. The CA% of linezolid, cefoxitin and gentamicin in coagulase-negative staphylococci were 98.9% (269/272), 94.5% (277/293) and 71.6% (194/271) respectively. Finally, for Enterococcus sp., the CA% of vancomycin and ampicillin were 91.5% (43/47) and 94.7% (36/38), respectively. Conclusion:Compared with the conventional AST, the blood culture-positive broth direct AST exhibited high category agreement and low error rates for both Gram-negative bacteria and Gram-positive cocci, which can serve a rapid alternative for AST in cases of clinical bloodstream infection.
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Objective:To evaluate whether the time to positive (TTP), handling time after positive alarm and turnaround time (TAT) of bacteremia blood culture can be shortened by optimizing blood culture workflow.Methods:This study was conducted retrospectively. Positive blood culture samples collected from Peking University People′s Hospital from January 1, 2014 to June 30, 2021 were analyzed in stages. In the traditional process stage of this study (2014), 502 bottles of positive blood culture samples were included in the analysis. In the first stage of process optimization (2016), the working time of staff was increased to 22:00, and 976 positive blood culture specimens were included in the analysis. In the second stage of process optimization (2018), the rapid identification process of MALDI-TOF MS was added, and a total of 1 029 bottles of positive blood culture samples were included. In the third stage of process optimization (2020) with the introduction of the new VIRTUO BACT/ALERT system. The difference of TTP, handling time after positive alarm and TAT of whole process in different stages of traditional process and process optimization were compared. All data were statistically significant when P<0.05 using rank-sum test. Results:In the traditional process stage (2014), the median quartile time of handling time after positive alarm was 55.70 (47.35, 68.45) h. In the first stage of process optimization (2016), the median quartile time of handling time after positive alarm was 47.25 (33.88, 59.96) h, and the handling time after positive alarm in the first stage of process optimization was significantly shorter than that in the traditional process stage ( Z=?10.734, P<0.001). In the second stage of process optimization (2018), the median quartile time for handling time after positive alarm was 47.18(36.41, 59.40) h, and 12.18% of the preliminary identification results of Gram-negative bacilli before 17:00 could be reported to the clinic before audit. In the third stage of process optimization (2020), the median quartile of TTP and TAT were 39.56 (21.52, 62.65) h and 78.16(64.68, 99.72) h respectively in the original BACT/ALERT 3D system. The new VIRTUO BACT/ALERT system had a median quartile of 37.03(21.08, 58.22) h for TTP and 73.41(62.88, 89.48) h for TAT. VIRTUO BACT/ALERT 3D had a significantly shorter TTP than BACT/ALERT 3D ( Z=?2.273, P=0.023), the TAT of VIRTUO BACT/ALERT system was significantly shorter than that of BACT/ALERT 3D system ( Z=?4.040, P<0.001). Conclusion:By improving the blood culture process of microbiology laboratory in many aspects and measures, the processing time of blood culture in each stage can be shortened and clinical benefits can be obtained.
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Background@#Identification of modifiable dietary factors, which are involved in the development of gestational diabetes mellitus (GDM), could inform strategies to prevent GDM. @*Methods@#We examined the dietary patterns in a Chinese population and evaluated their relationship with GDM risk using a case-control study including 1,464 cases and 8,092 control subjects. Propensity score matching was used to reduce the imbalance of covariates between cases and controls. Dietary patterns were identified using factor analysis while their associations with GDM risk were evaluated using logistic regression models. @*Results@#A “vegetable” dietary pattern was characterized as the consumption of green leafy vegetables (Chinese little greens and bean seedling), other vegetables (cabbages, carrots, tomatoes, eggplants, potatoes, mushrooms, peppers, bamboo shoots, agarics, and garlic), and bean products (soybean milk, tofu, kidney beans, and cowpea). For every quartile increase in the vegetables factor score during 1 year prior to conception, the first trimester, and the second trimester of pregnancy, the GDM risk lowered by 6% (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.89 to 0.99), 7% (OR, 0.94; 95% CI, 0.88 to 0.99), and 9% (OR, 0.91; 95% CI, 0.86 to 0.96). @*Conclusion@#In conclusion, our study suggests that the vegetable dietary pattern is associated with lower GDM risk; however, the interpretation of the result should with caution due to the limitations in our study, and additional studies are necessary to explore the underlying mechanism of this relationship.
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Background@#Identification of modifiable dietary factors, which are involved in the development of gestational diabetes mellitus (GDM), could inform strategies to prevent GDM. @*Methods@#We examined the dietary patterns in a Chinese population and evaluated their relationship with GDM risk using a case-control study including 1,464 cases and 8,092 control subjects. Propensity score matching was used to reduce the imbalance of covariates between cases and controls. Dietary patterns were identified using factor analysis while their associations with GDM risk were evaluated using logistic regression models. @*Results@#A “vegetable” dietary pattern was characterized as the consumption of green leafy vegetables (Chinese little greens and bean seedling), other vegetables (cabbages, carrots, tomatoes, eggplants, potatoes, mushrooms, peppers, bamboo shoots, agarics, and garlic), and bean products (soybean milk, tofu, kidney beans, and cowpea). For every quartile increase in the vegetables factor score during 1 year prior to conception, the first trimester, and the second trimester of pregnancy, the GDM risk lowered by 6% (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.89 to 0.99), 7% (OR, 0.94; 95% CI, 0.88 to 0.99), and 9% (OR, 0.91; 95% CI, 0.86 to 0.96). @*Conclusion@#In conclusion, our study suggests that the vegetable dietary pattern is associated with lower GDM risk; however, the interpretation of the result should with caution due to the limitations in our study, and additional studies are necessary to explore the underlying mechanism of this relationship.
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Objective:To study the effects of different pre-sequencing sample processing modes on the results of whole genome sequencing with high-throughput sequencing (HTS) by taking the largest RNA virus (human coronavirus, HCoV) as the representative.Methods:Cell-cultured human coronavirus HCoV-OC43 strains were used as the representative samples and divided into different groups based on pre-sequencing processing modes as follows: untreated group, DNase and RNase treatment before nucleic acid extraction group, DNase treatment after nucleic acid extraction group, and DNase and RNase treatment before nucleic acid extraction and DNase treatment after nucleic acid extraction group. Nucleic acid samples of each group were analyzed by direct RNA sequencing (without amplification) and DNA sequencing after sequence independent single primer amplification (SISPA), respectively.Results:No significant difference in viral genome coverage rates was observed between different groups. The highest genome coverage and sequencing accuracy were obtained in DNase treatment after nucleic acid extraction group by direct RNA sequencing, and the ratio of viral reads and the sequencing depth of each locus were effectively improved by SISPA amplification.Conclusions:This study provided an optimized technical strategy for whole genome sequencing of RNA viruses such as coronavirus.
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Objective@#To investigate the relations between dietary intake during pregnancy and the incidence of their babies with small for gestational age (SGA).@*Methods@#Data on demographics, dietary intake of protein, fat, and carbohydrates of the pregnant mothers during the first, second and third trimester, were collected. Information related to birth weight and gestational age of the infants were also gathered. A total of 8 102 women, who delivered their babies at the First Affiliated Hospital of Shanxi Medical University from March 2012 to September 2016, were enrolled in this project. Among them, 961 mothers had infants with SGA but the other 7 141 of them having normal infants. Unconditional logistic regression model was used to analyze the effect of dietary nutrient intake on SGA the first, second and third trimester.@*Results@#We found that low dietary intake of protein during the first trimester and following trimesters during pregnancy were positively associated with higher risk of SGA (OR=1.534, 95%CI: 1.217-1.934; OR=1.268, 95%CI: 1.005-1.599; OR=1.310, 95%CI: 1.036-1.655). When adjusting for maternal pre-pregnancy BMI, we found that when mothers were with a pre-pregnancy BMI less than 18.5 or with low maternal intake of protein during the first trimester, positive association with higher risk of SGA (OR=1.872, 95%CI: 1.033-3.395; OR=1.754, 95%CI: 1.125-2.734), was noticed. However, for mothers with a pre-pregnancy BMI between 18.5 and 24.0 or with low protein intake during the first trimester, significant association with higher risk of SGA (OR=1.465, 95%CI: 1.089-1.972) was found.@*Conclusions@#Through our observation, maternal dietary intake during pregnancy seemed to be associated with the risk of SGA but the effects of dietary intake were different, according to the BMI of pre-pregnancy population. Early pregnancy appeares as the key period for dietary intake which may influence the SGA.
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Objective To investigate the influence of dietary cholesterol intake on gestational diabetes mellitus (GDM),at one year prior to and first and second trimesters of pregnancy.Methods Between March 2012 and September 2016,the pregnant women from the First Affiliated Hospital of Shanxi Medical University were asked to fill in a set of questionnaires,by which information on general demographic characteristics,diagnosis of GDM and dietary cholesterol intake was collected.Unconditional logistic regression method was used to analyze the influence of dietary cholesterol intake on GDM,at one year prior to and first and second trimesters of pregnancy.The association on dietary cholesterol intake and GDM between age groups was also analyzed.Results Data on 9 005 subjects,including 1 388 pregnant women with GDM,was collected.When the amount of cholesterol intake was stratified into quartile,results from the unconditional logistic regression showed that dietary cholesterol intake appeared ≥76.50 mg/d,both in the periods of one year prior to and the second trimester of pregnancy.This amount of dietary cholesterol intake would increase the risk of GDM (one year prior to pregnant:OR=1.230,95％CI:1.018-1.485;second trimester:OR=1.228,95％C1:1.014-1.486).Women who took ≥76.50 mg/d of daily cholesterol during the period of one year prior to,or 46.75-76.50 mg/d during the second trimester of pregnancy,the risks of GDM (OR=4.644,95％CI:1.106-19.499) would increase.Women with daily cholesterol intake over 76.50 mg/d during the period of one year prior to or at the second trimester of pregnancy,there appeared a risk on GDM (OR=1.217,95％ CI:1.012-1.463).When maternal age was divided in two different subgroups and the cholesterol intake level was ≥76.50 mg/d both in the period of one year prior to pregnancy or at the second trimester,the risk of GDM appeared in the subgroup of ＜35 years old (OR=1.336,95％CI:1.083-1.647;OR=1.341,95％CI:1.087-1.654).However,no significant association was found in the maternal age group of ≥35 years old.Conclusion High level of dietary cholesterol intake would increase the risk of GDM,both in the period of one year prior to and at the second trimester of pregnancy.
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To investigate the resistance mechanisms of tigecycline-non-susceptible Acinetobacter baumannii and for providing the evidence of the control of nosocomial infection and rational use of antibiotics. The minimum inhibitory concentrations (MICs) of 94 non repetitive tigecycline-non-susceptible A. baumannii from 20 hospitals in 12 cities of China were determined by agar dilution method and broth microdilution method. The molecular epidemiology was studied by Multilocus sequence typing (MLST) and eBURST software. PCR and sequencing techniques were used to analyze the resistance genes (blaOXA-40-like, blaOXA-58-like, blaOXA-23-like, blaOXA-51-like, blaNDM-1), ISAba1, and the mutation sites of adeR, adeS, and trm. The activity of polymyxin B and minocyclinem against tigecycline-non-susceptible A. baumannii were 100% and 25.5%, respectively. The sensitivities of other antibiotics were less than 3.5%, and the sensitivities of imipenem and meropenem totigecycline-nonsusceptible A. baumannii were only 1.1%. A total of 12 ST types were identified, including ST195 (45, 47.9%), ST208 (19, 20.2%) and ST457 (10, 10.6%). EBURST analysis found that 8 of the ST types belonged to the clone complex 92 (Clonal Complex 92, CC92). The blaOXA-23-like type carbapenem gene was identiefied in 93 strains (99% positive); and none of the strains contained the blaNDM-1 gene. The detection rates of adeR and adeS were 73.4% and 91.5% respectively and high frequency mutation sites were located in adeR (Asp26Asn) and adeS (Ala97Glu); The ISAba1 located upstream of the adeS gene was detected in 12 strains of A. baumannii, mainly from the northern region of China. The 240 nucleotide deletion of the trm gene caused a frameshift leading to a premature stop. So the tigecycline-non-susceptible A. baumannii showed high resistance against most antibiotics except polymyxin B. The deletion and mutation of adeR, adeS and trm were the main resistant mechanisms in tigecycline-non-susceptible A. baumannii in China.
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Objective: To present the evolutionary path of Chinese Medical Ethics, analyze the development vein of periodical, explore the journal' s research focuses, and provide reference for related personnel to understand the development of the current research status in the field through visualization technology. Methods:Using biblio-metric method,taking "China National Knowledge Infrastructure" as source of data collection, we used the visual-ization software CiteSpace to draw scientific knowledge maps and analyzed literatures published from 1990 to 2014 in Chinese Medical Ethics. Results:The annualvolume of journal articles fluctuated upwards,with peaks in 1992, 2000 and 2009, and of which the most was in 2009, with 393 articles. "Medical Ethics" and "Doctor-patient Relationship" were hotwords in this field. The publications of domestic and foreign scholars promoted the interna-tional exchange and the development of Chinese medical ethics, and the most productive institutions were often col-leges or universities. Conclusion:Chinese Medical Ethics has effectively promoted the development of bioethics in China, more and more scholars are involved in the relative research of medical ethics, and the old, middle and young scientists and research teams inherit, cooperate and develop with each other. The cross-regional, inter-a-gency and interdisciplinary collaboration remains very limited, whichwill become the important factorinfluencingthe development of the field of Chinese medical ethics in the future.
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Objective To investigate the influence of dietary cholesterol intake on gestational diabetes mellitus (GDM),at one year prior to and first and second trimesters of pregnancy.Methods Between March 2012 and September 2016,the pregnant women from the First Affiliated Hospital of Shanxi Medical University were asked to fill in a set of questionnaires,by which information on general demographic characteristics,diagnosis of GDM and dietary cholesterol intake was collected.Unconditional logistic regression method was used to analyze the influence of dietary cholesterol intake on GDM,at one year prior to and first and second trimesters of pregnancy.The association on dietary cholesterol intake and GDM between age groups was also analyzed.Results Data on 9 005 subjects,including 1 388 pregnant women with GDM,was collected.When the amount of cholesterol intake was stratified into quartile,results from the unconditional logistic regression showed that dietary cholesterol intake appeared ≥76.50 mg/d,both in the periods of one year prior to and the second trimester of pregnancy.This amount of dietary cholesterol intake would increase the risk of GDM (one year prior to pregnant:OR=1.230,95％CI:1.018-1.485;second trimester:OR=1.228,95％C1:1.014-1.486).Women who took ≥76.50 mg/d of daily cholesterol during the period of one year prior to,or 46.75-76.50 mg/d during the second trimester of pregnancy,the risks of GDM (OR=4.644,95％CI:1.106-19.499) would increase.Women with daily cholesterol intake over 76.50 mg/d during the period of one year prior to or at the second trimester of pregnancy,there appeared a risk on GDM (OR=1.217,95％ CI:1.012-1.463).When maternal age was divided in two different subgroups and the cholesterol intake level was ≥76.50 mg/d both in the period of one year prior to pregnancy or at the second trimester,the risk of GDM appeared in the subgroup of ＜35 years old (OR=1.336,95％CI:1.083-1.647;OR=1.341,95％CI:1.087-1.654).However,no significant association was found in the maternal age group of ≥35 years old.Conclusion High level of dietary cholesterol intake would increase the risk of GDM,both in the period of one year prior to and at the second trimester of pregnancy.
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Objective To reveal the prevalence and the related factors of hepatitis B (HepB) virus infection among HIV/AIDS patients.Methods We conducted a cross-sectional study in two HIV clinics,affiliated to local Centers of Disease Control and Prevention in Guangxi Zhuang Autonomous Regional.A face-to-face interview,with questionnaire was conducted to collect information on socio-demographic characteristics,drug use,and sexual behavior.Blood samples were used to test HBsAg.x2 test or Fisher's exact test and unconditional logistic regression models were used to identify the influencing factors.Results The prevalence of HBV and HIV co-infection was 13.85％ (113/816).Results from multivariate logistic regression analyses showed that age (25-45),family history of HBV and history of HepB vaccination were independent influencing factors for HBV and HIV coinfection,with OR (95％ CI) as 1.738 (1.031-2.931),2.898 (1.678-5.005) and 1.744 (1.052-2.892),respectively.Conclusion The prevalence of HBV among HIV/AIDS patients was significantly higher than that in general population.HIV/AIDS patients aged between 25 and 45 and with family history of HBV were more likely to be infected with HBV,while HepB vaccination was associated with the reduction of HIV/HBV coinfection.Specific comprehensive prevention and treatment programs on HIV/AIDS patients need to be set up.
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Objective To investigate the association between periconceptional folic acid supplementation and small for gestational age (SGA) birth based on maternal pre-pregnancy body mass index (BMI) and provide evidence for the development of comprehensive prevention programs on SGA birth.Methods Between March,2012 and September,2016,a total of 8 523 pregnant women delivering in the First Affiliated Hospital of Shanxi Medical University were surveyed to collect the information about their demographic characteristics,folic acid supplementation before and during pregnancy and about their infants.Among their infants,1 066 were small for gestational age (case group),7 457 were appropriate for gestational age (AGA) (control group).Unconditional logistic regression model was used to evaluate the association between periconceptional folic acid supplementation and SGA birth in the context of different pre-pregnancy BMI.Results The overall incidence of SGA birth was 12.51％ (1 066/8 523).After adjusting the confounding factors,prepregnancy BMI＜ 18.5 kg/m2 was a risk factor for SGA birth (OR=1.22,95％ CI:1.01-1.47),prepregnancy BMI≥24.0 kg/m2 was associated with a reduced risk of SGA birth (OR=0.81,95％CI:0.68-0.97).After adjusting confounding factors,periconceptional folic acid supplementation was a protective factor for SGA birth (OR=0.82,95％CI:0.68-0.98).After stratified by pre-pregnancy BMI,periconceptional folic acid supplementation was associated with the reduced risk of SGA birth in overweight group (24.0 kg/m2≤BMI＜28.0 kg/m2) with OR of 0.55 (95％CI:0.36-0.85).No significant association was observed in other groups.When examined by folic acid supplement type,periconceptional single folic acid supplementation (400 μg per tablet) was a protective factor for SGA birth (OR=0.82,95％ CI:0.69-0.99).After stratified by pre-pregnancy BMI,periconceptional single folic acid supplementation (400 μg per tablet) was associated with the reduced risk of SGA birth in overweight groups (OR =0.56,95 ％ CI:0.36-0.86).No association was observed between periconceptional folic acid containing multivitamin supplementation and SGA birth.Conclusions Periconceptional folic acid supplementation (400 μg) was associated with reduced risk of SGA birth in women with prepregnancy BMI≥24.0 kg/m2 and ＜28.0 kg/m2.No association between folic acid supplementation and SGA was observed in other groups.This study suggests that pre-pregnancy BMI might modify the influence of folic acid supplementation on the risk of SGA birth.
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Objective:To develop the Abusive Behavior Scale for Superiors under the Chinese context (ABSSC) and test its validity and reliability.Methods:Based on literature analysis and the open questionnaire survey in 32 employees,this study defined the construct of ASBSS,and compiled the preliminary questionnaire.A sample of 200 employees coming from companies was selected for item analysis.A sample of 445 employees was investigated with this questionnaire,223 of them were assessed for exploratory factor analysis and 222 of them were assessed for confirmatory factor analysis and internal consistency test with 2 week interval.Results:The ABSSC consisted of 11 items in 3 factors,which were neglect and slander,obstructionism and hard on subordinates.The 3 factors explained 55.45％ of the total variance.Furthermore,the result of CFA indicated that the model fitted the data with well constmct validity (RMSEA =0.06,GFI =0.94,NFI =0.92,CFI =0.96,IFI =0.96).The Cronbach α coefficient of the whole scale and its three facts were 0.87,0.79,0.78,and 0.76,respectively.Conclusion:It suggests that the Abusive Behavior Scale for superiors under the Chinese context (ABSSC) is reliable and valid enough to be applicable to measure superiors' abusive behavior under the background of Chinese culture.
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Objective To reveal the prevalence and the related factors of hepatitis B (HepB) virus infection among HIV/AIDS patients.Methods We conducted a cross-sectional study in two HIV clinics,affiliated to local Centers of Disease Control and Prevention in Guangxi Zhuang Autonomous Regional.A face-to-face interview,with questionnaire was conducted to collect information on socio-demographic characteristics,drug use,and sexual behavior.Blood samples were used to test HBsAg.x2 test or Fisher's exact test and unconditional logistic regression models were used to identify the influencing factors.Results The prevalence of HBV and HIV co-infection was 13.85％ (113/816).Results from multivariate logistic regression analyses showed that age (25-45),family history of HBV and history of HepB vaccination were independent influencing factors for HBV and HIV coinfection,with OR (95％ CI) as 1.738 (1.031-2.931),2.898 (1.678-5.005) and 1.744 (1.052-2.892),respectively.Conclusion The prevalence of HBV among HIV/AIDS patients was significantly higher than that in general population.HIV/AIDS patients aged between 25 and 45 and with family history of HBV were more likely to be infected with HBV,while HepB vaccination was associated with the reduction of HIV/HBV coinfection.Specific comprehensive prevention and treatment programs on HIV/AIDS patients need to be set up.
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Objective To investigate the association between periconceptional folic acid supplementation and small for gestational age (SGA) birth based on maternal pre-pregnancy body mass index (BMI) and provide evidence for the development of comprehensive prevention programs on SGA birth.Methods Between March,2012 and September,2016,a total of 8 523 pregnant women delivering in the First Affiliated Hospital of Shanxi Medical University were surveyed to collect the information about their demographic characteristics,folic acid supplementation before and during pregnancy and about their infants.Among their infants,1 066 were small for gestational age (case group),7 457 were appropriate for gestational age (AGA) (control group).Unconditional logistic regression model was used to evaluate the association between periconceptional folic acid supplementation and SGA birth in the context of different pre-pregnancy BMI.Results The overall incidence of SGA birth was 12.51％ (1 066/8 523).After adjusting the confounding factors,prepregnancy BMI＜ 18.5 kg/m2 was a risk factor for SGA birth (OR=1.22,95％ CI:1.01-1.47),prepregnancy BMI≥24.0 kg/m2 was associated with a reduced risk of SGA birth (OR=0.81,95％CI:0.68-0.97).After adjusting confounding factors,periconceptional folic acid supplementation was a protective factor for SGA birth (OR=0.82,95％CI:0.68-0.98).After stratified by pre-pregnancy BMI,periconceptional folic acid supplementation was associated with the reduced risk of SGA birth in overweight group (24.0 kg/m2≤BMI＜28.0 kg/m2) with OR of 0.55 (95％CI:0.36-0.85).No significant association was observed in other groups.When examined by folic acid supplement type,periconceptional single folic acid supplementation (400 μg per tablet) was a protective factor for SGA birth (OR=0.82,95％ CI:0.69-0.99).After stratified by pre-pregnancy BMI,periconceptional single folic acid supplementation (400 μg per tablet) was associated with the reduced risk of SGA birth in overweight groups (OR =0.56,95 ％ CI:0.36-0.86).No association was observed between periconceptional folic acid containing multivitamin supplementation and SGA birth.Conclusions Periconceptional folic acid supplementation (400 μg) was associated with reduced risk of SGA birth in women with prepregnancy BMI≥24.0 kg/m2 and ＜28.0 kg/m2.No association between folic acid supplementation and SGA was observed in other groups.This study suggests that pre-pregnancy BMI might modify the influence of folic acid supplementation on the risk of SGA birth.
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Objective To elucidate the resistance mechanisms of clinical colistin-resistant Klebsiella pneumoniae and Escherichia coli isolates in China.Methods A total of 964 K.pneumoniae and 1 389 E. coli isolates were retrospectively collected from national surveillance programs from 2011 to 2014 in China. Antimicrobial susceptibility testing was determined by the microdilution method.The PCR amplification followed by sequencing was used to detect the mcr-1 gene and colistin-resistance genes, including mgrB, pmrB and phoQ.Real-time quantitative PCR was performed to examine the relative transcriptional levels of pmrB, pmrC, pmrD, pmrK and pmrE genes in K.pneumoniae, and pmrA, pmrB, pmrC, phoP and phoQ genes in E.coli.Conjugation experiment was used to detect the transferability of the resistance plasmid carrying the mcr-1 gene.Statistical analyses were performed using IBM SPSS Statistics (version 16.0) and a P value <0.05 was considered statistically significant. Results The colistin-resistant rates of K. pneumoniae and E.coli were 0.62% ( 6/964 ) and 1.66% ( 23/1 389 ) , respectively.No amino acids substitutions were identified in mgrB genes among colistin-resistant isolates.Among six colistin-resistant K. pneumoniae isolates, five isolates were identified to have point mutations in pmrB gene, but no point substitution was detected in phoQ gene.One to four point mutations had been found in pmrB and phoQ genes in colistin-resistant E.coli isolates, respectively.The expression level of pmrB, pmrC, pmrD, pmrK and pmrE genes showed no significant difference between colistin-resistant and colistin-susceptible isolates [pmrB, (1.04 ±1.12) vs.(0.94 ±0.67), P=0.945; pmrC, (1.39 ±2.01) vs.(0.16 ±0.27), P=0.101;pmrD, (1.59 ±2.43) vs.(0.88 ±0.34),P=0.445;pmrK, (0.64 ±0.62) vs.(0.04 ±0.10), P=0.051;pmrE, (3 492 833 388.83 ±8 478 977 986.85) vs.(20 771 428.93 ±38 000 732.85), P=0.445].However, the transcriptional level of pmrB genes in colistin-resistant group was 9.5-fold higher than that of the colistin-susceptible group in E.coli isolates.Four in six colistin-resistant K.pneumoniae isolates possessed mcr-1 gene, whereas all of the colistin-resistant E. coli had the mcr-1 gene. The conjugation verified the transferability rate of the plasmid carrying mcr-1 gene was 5.78 ×10-6 , and the MIC value of colistin of the conjugant increased 21-fold than the recipient strain.Conclusions Plasmid-mediated mcr-1 gene was the major reason for colistin resistance in clinical isolates of K.pneumoniae and E.coli. Some other resistance mechanisms such as transcriptional up-regulated pmrB gene also involved in colistin resistance.
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<p><b>OBJECTIVE</b>To evaluate the long-term protection efficacy of neonatal hepatitis B vaccination on chronic hepatitis B (CHB) and liver fibrosis and cirrhosis in adults.</p><p><b>METHODS</b>From January to October, 2013, a cross-sectional study was conducted among the participants from Qidong Hepatitis B Intervention Study (QHBIS), who were selected through stratified random sampling. The detections of serum alanine aminotransferase (ALT), HBsAg, anti-HBs, anti-HBc, HBeAg, and anti-HBe were conducted and ultrasonography on liver, gallbladder and spleen was performed for them. The positive rates of each serologic markers, the prevalence of active CHB and liver fibrosis and cirrhosis were calculated, the gender specific differences between vaccination group and control group were compared with Chi-square test.</p><p><b>RESULTS</b>A total of 4 421 participants aged (25.59±1.84) years in vaccination group and 3 880 participants aged (26.61±2.24) years in control group were surveyed. The positive rates of HBsAg, anti-HBs, anti-HBc, HBeAg and anti-HBe were 2.38%, 37.73%, 3.78%, 0.57% and 2.15% in vaccination group, and 9.02%, 29.41%, 16.83%, 2.73% and 8.87% in control group, respectively, the differences between two groups were statistically significant (all P<0.05). The prevalence of active CHB and liver fibrosis and cirrhosis were 0.45% and 0.16% in vaccination group, 1.29% and 0.39% in control group, the differences between two groups were statistically significant (P<0.05). The active CHB prevalence was lower in females than in males in both vaccination group and control group (P<0.05). The liver fibrosis and cirrhosis prevalence was lower in females than in males in control group (P<0.05); whereas, no statistical significant difference in liver fibrosis & cirrhosis prevalence between males and females was found in vaccination group (P>0.05).</p><p><b>CONCLUSIONS</b>Protection conferred by neonatal hepatitis B vaccination could last to marrying age. The gender specific difference in protection efficacy needs further study.</p>
Subject(s)
Adult , Female , Humans , Male , China , Cross-Sectional Studies , Hepatitis B Antibodies , Blood , Hepatitis B Surface Antigens , Blood , Hepatitis B Vaccines , Therapeutic Uses , Hepatitis B virus , Hepatitis B, Chronic , Liver Cirrhosis , Prevalence , VaccinationABSTRACT
<p><b>OBJECTIVE</b>To investigate the association between ambient fine particulate matter with aerodynamic diameter less than 2.5 μm (PM2.5) and the risk on preterm birth.</p><p><b>METHODS</b>A total of 1 882 pregnant women with local residency of Taiyuan city and underwent delivery at the First Hospital of Shanxi Medical University with the dates of conception between January 1 and December 31, 2013, were enrolled in the study. Information on general demographics, home address and history on pregnancy, lifestyle and related environmental factors were collected through in-person interview. Birth outcomes and maternal complications were abstracted from medical records. Data on the amount of daily average PM2.5 from 8 monitor points in Taiyuan city, between March 1, 2012 and December 31, 2013 were also collected. Individual exposure during pregnancy were calculated using the inverse-distance weighting method, based on home address. Multivariate unconditional logistic regression model was used to examine the associations among PM2.5 exposure, risk of preterm birth and related clinical subtypes.</p><p><b>RESULTS</b>The overall incidence of preterm birth was 8.21% (151/1 839)in 1 839 pregnant women. Exposure to ambient PM2.5 during the second week prior to delivery was associated with an increased risk of preterm birth (OR=1.087, 95% CI: 1.001-1.182 per 10 μg/m(3) increase) and mild preterm birth (OR=1.099, 95% CI: 1.007-1.200 per 10 μg/m(3)). Compared to data from the China Environmental Air Quality Standard, higher level of exposure (≥75 μg/m(3)) of PM2.5 during the second week before delivery was associated with an increased risk of preterm birth (OR=1.008, 95%CI: 1.000-1.017) but the association was mainly seen for mild preterm birth (OR=1.010, 95%CI: 1.001-1.018).</p><p><b>CONCLUSIONS</b>RESULTS from our study showed that exposure to high level of PM2.5 during late pregnancy would increase the risk of preterm birth. Future large studies are needed to examine the association by preterm clinical subtypes and to elucidate potential underlying mechanisms.</p>
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , China , Epidemiology , Environmental Exposure , Incidence , Logistic Models , Maternal Exposure , Particle Size , Particulate Matter , Toxicity , Pregnancy Complications , Premature Birth , Epidemiology , Public HealthABSTRACT
Drug resistance is becoming a serious issue worldwide.Obtaining accurate antimicrobial susceptibility results requires refined standard operation procedures,thus achieving the goal of individual therapy.The interpretive criteria CLSI revised annually causes widespread concern of clinical microbiologists.The major changes in CLSI M100-S25 are described in this article,focusing on the introduction of Carba NP confirmatory test for suspected carbapenemase production and epidemiological cutoff values.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the relationship between maternal pre-pregnancy body mass index, weight gain during pregnancy and small for gestational age (SGA) birth so as to provide evidence for the development of comprehensive prevention programs on SGA birth.</p><p><b>METHODS</b>Between March, 2012 and July, 2014, 4 754 pregnant women were asked to fill in the questionnaires which were collected from the First Affiliated Hospital of Shanxi Medical University. Data related to general demographic characteristics, pregnancy and health status of those pregnant women was collected and maternal pre-pregnancy body mass index and maternal weight gain were calculated. Subjects were divided into different groups before the effect of maternal pre-pregnancy body mass index and weight gain during pregnancy on SGA birth were estimated.</p><p><b>RESULTS</b>The overall incidence of SGA birth was 9.26% (440/4 754). Proportions of SGA birth from pre-pregnant, underweight group, normal weight group, overweight and obese groups were 9.85%, 8.54% and 9.45%, respectively. Results from multi-factor logistic regression analyses showed that after adjusting the confounding factors as age, history on pregnancies etc., women with high pre-pregnancy BMI showed a lower incidence of SGA than those under normal pre-pregnancy BMI (OR = 0.714, 95% CI: 0.535-0.953). Different weight gains during pregnancy were statistically significant (χ(2) = 8.811, P = 0.012). Incidence of SGA birth that was below the recommended range in the 2009 Institute of Medicine Guidelines (12.20%) was higher than those within (9.23%) or beyond (8.45%) the recommended range. Results from the multi-factor logistic regression analyses showed that, after adjusting the confounding factors as age, pregnancy history etc., factor as weight gain below the recommended level could increase the risk of SGA (OR = 1.999, 95% CI: 1.487-2.685). In the underweight, normal weight, overweight or obese groups, with weight gain during pregnancy below the range, the incidence of SGA showed an increase (OR = 2.558, 95% CI: 1.313-4.981, OR = 1.804, 95% CI: 1.258-2.587, OR = 3.108, 95% CI: 1.237-7.811). There was no interaction of addictive or multiplicative models between these two factors under 'interaction analysis'.</p><p><b>CONCLUSION</b>Women with high pre-pregnancy BMI presented a lower incidence of SGA than those within the normal range. Insufficient weight gain during pregnancy could increase the risk of SGA delivery. These findings called for attention to be paid to the gestational weight gain, in order to decrease the risk of SGA.</p>