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This work aims to evaluate a rapid detection method of carbapenem resistance genes in blood cultures based on Xpert Carba-R and preliminarily evaluate its clinical application.Methods:Sixteen strains of Enterobacterales carrying different carbapenem resistance genes were selected to prepare simulated positive blood culture samples and Xpert Carba-R was used to directly detect carbapenem resistance genes in the simulated positive blood culture. From January 2022 to June, a prospective study was conducted on a total of 117 Enterobacteriaceae-positive blood culture samples in the First Affiliated Hospital of Nanjing Medical University. Xpert Carba-R, detecting five kinds of carbapenem resistance genes in these samples, was evaluated in sensitivity and specificity compared to polymerase chain reaction sequencing. Meanwhile clinical data of positive patients was collected for prognostic analysis. Results:Of the 16 simulated specimens, 14 strains had carbapenem resistance genes detected by Xpert Carba-R, including 8 bla KPC, 5 bla NDM and 1 bla IMP, showing 100% agreement with the known results. As of the 117 clinical specimens, 28 cases were determined to be Enterobacterales harboring carbapenem resistance genes, including 24 bla KPC, 2 bla NDM and 2 bla KPC+ bla NDM. In comparison to the PCR sequencing, the sensitivity and specificity of Xpert Carba-R were both 100% for blood culture samples, and furthermore, the detection time was significantly reduced. Of the 25 positive patients, 9 cases were treated with monotherapy and 5 cases were effective, other 16 cases received combined treatment and 12 cases were effective. A total of 17 cases were effective, 8 cases were ineffective and 3 of them died, the mortality rate was 12% (3/25). Conclusion:Xpert Carba-R can rapidly and accurately detect carbapenem resistance genes in blood culture, which can provide evidence for rational drug therapy in early clinical stage.
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Objective To investigate the microbial contamination and management of refrigerators in the ward treatment rooms of a tertiary first-class hospital,and provide reference for strengthening the cleaning and disinfec-tion of medical refrigerators in the ward treatment rooms.Methods A total of 40 refrigerators in use from the treatment rooms of different wards in the hospital were randomly selected for microbial sampling,culture,and bac-terial identification.Forty nurses were randomly chosen from the corresponding wards for a questionnaire survey on the daily management of refrigerators.Results A total of 223 specimens were collected,with 142 microbial positive specimens and a positive rate of 63.68％.A total of 247 bacterial strains were detected,including 41.30％(n=102)Gram-positive bacteria,10.93％(n=27)Gram-negative bacteria,and 47.77％(n=118)fungi.Two strains of multidrug-resistant Pseudomonas aeruginosa from the bottom and drainage tank of the same refrigerator from class-Ⅲ environment were detected,with a detection of multidrug-resistant organisms being 0.90％(2/223).The fre-quency and methods of routine cleaning and disinfection of refrigerators varied among different wards.Conclusion There are deficiencies in the cleaning and disinfection management of refrigerators in ward treatment rooms of medi-cal institutions.More attention should be paid to the cleaning and disinfection of refrigerators in wards.The health-care-associated infection management departments should strengthen corresponding supervision and management.
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@#Objective To explore the short-term efficacy and safety of pembrolizumab combined with chemotherapy in the neoadjuvant treatment of non-small cell lung cancer. Methods The clinical data of 11 male patients with non-small cell lung cancer who underwent pembrolizumab combined with neoadjuvant chemotherapy in the Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University from December 2019 to June 2021 were retrospectively analyzed. The average age of the patients was 52.0-79.0 (62.0±6.9) years. The imaging data and pathological changes before and after neoadjuvant treatment were compared, and adverse reactions during neoadjuvant treatment were recorded. Objective remission rate (ORR) and main pathological remission rate (MPR) and pathological complete remission rate (pCR) were the main observation endpoints. Results After preoperative neoadjuvant therapy with pembrolizumab combined with platinum or paclitaxel, all patients successfully underwent thoracoscopic radical resection of lung cancer. The ORR was 72.7%, and the MPR was 81.8%. Among them, 45.5% of patients achieved pCR. The main adverse reactions were hypoalbuminemia, decreased appetite and nausea. The mortality rate within 30 days after surgery was 0, and no tumor metastasis was observed. Conclusion Pembrolizumab combined with neoadjuvant chemotherapy is safe and feasible to treat non-small cell lung cancer, and the short-term efficacy is beneficial.
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Four unreported monoterpene indole alkaloids, tabernaecorymines B-E (1-4), together with twenty-one known indole alkaloids (5-25) were obtained from the stem bark of Tabernaemontana corymbosa. Their structures and absolute configurations were elucidated by extensive spectroscopy, quantum chemical calculations, DP4+ probability analyses and Mo2(OAc)4-induced electronic circular dichroism experiment. The antibacterial and antifungal activities of these compounds were evaluated and some of them showed significant activity against Staphylococcus aureus,Bacillus subtilis, Streptococcus dysgalactiae and Candida albicans.
Subject(s)
Tabernaemontana , Anti-Infective Agents , Antifungal Agents , Anti-Bacterial Agents , Indole Alkaloids摘要
Objective To investigate the changes of blood related parameters and coagulation function indicators in patients with funge-mia during hospitalization,and analyze the clinical significance of these changes and their impact on the patients'prognosis.Methods The patients with positive fungus blood culture for the first time and diagnosed as fungal bloodstream infection during December 2018 and October 2022 were retrospectively analyzed.Their blood related parameters and coagulation function indicators at admission and the time of positive blood culture were collected,and the differences of these clinical parameters were analyzed.The patients were divided into the survival group and death group based on their prognosis,and the differences in clinical parameters between the two groups were compared using the Mann-Whitney U test.The Logistic regression analysis was used to analyze the risk factors related to death.Results A total of 87 patients were enrolled in the study.The patients'results of monocyte count,lymphocyte count,and platelet(PLT)at the time of positive blood culture were significantly lower than those at admission(P＜0.001),while the levels of platelet-associated pa-rameters MPV and PDW were significantly increased(P＜0.05).The levels of coagulation function indicators such as PT,APTT,and D-dimer at the time of positive blood culture were significantly higher than those at admission(P＜0.05).Compared with the the surviv-al group,the peripheral blood PLT count in the death group at the time of positive blood culture was significantly reduced(P=0.022),while the PT,APTT and TT levels were significantly increased(P＜0.05).Logistic regression analysis showed that the death of patients was significantly correlated with the lower level of PLT(OR=1.46,95％CI:1.08-1.97,P=0.01).Conclusion The fungal infection in hospitalized patients can lead to a decrease in PLT count and the prolongation of PT and APTT.Low levels of PLT are associated with the patients'prognosis,and monitoring its changes can assist in assessing the patients'conditions and prognosis.
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@#Surgery is a classic traditional method for the treatment of early-stage esophageal cancer, and it is also recognized as an effective first-choice method in the medical community. With the development of endoscopic technology, esophagus-preserving comprehensive treatment of esophageal cancer has almost the same or even better effects in some aspects in the treatment of early esophageal cancer than surgery. Many clinical guidelines have also recommended it as the first-choice treatment for early esophageal cancer. The room for surgical treatment of esophageal cancer has been further compressed. This article discusses the comprehensive treatment model of esophageal cancer from the perspective of thoracic surgery, aiming to find a new position of thoracic surgery in the treatment of esophageal cancer.
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In this study, the reverse engineering technology was used to analyze the prescription and process of Doppelherz® Energy DIRECT, based on the composition of the prescription on the official website of the product, the detection method of composition is established according to the pharmacopoeia and literature information, combined with gravimetric analysis to complete prescription analysis. The prescription composition of the reference listed drug was determined to be composed of caffeine, taurine, vitamin B, anhydrous glucose, citric acid, sorbitol, sucralose, magnesium salts of fatty acids, in which the glucose content was 71.4%, the citric acid content was 7.0% and the magnesium salts of fatty acids content was < 5.8%. According to patent inquiry, Raman imaging and other technologies, the preparation process of the marketed preparation has been basically obtained, and the development of the self-made preparation has been completed on this basis. The study was approved by the Ethics Committee of the Academy of Military Medical Sciences. Combined with the results of the taste evaluation experiment and the caffeine dissolution test of the preparation in 1 min, the hot-melt extrusion technology was screened out as the taste-masking technology of the self-made preparation, the parameters of the hot-melt extrusion process were screened by differential scanning calorimetry analysis, and finally a product with good taste and qualified quality was obtained, which provided a reference method for the research and development of related preparations.
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BACKGROUND@#Lung cancer has the highest mortality in China. Different treatments are of great significance to the prognosis of patients. By comparing stage Ia non-small cell lung cancer (NSCLC) patients' survival rates for ablation and for sub-lobectomy, we studied the difference in the effects of the two treatments on patient prognosis.@*METHODS@#Using the Surveillance, Epidemiology, and End Results (SEER) database, we screened eligible patients with stage Ia NSCLC from January 2004 to December 2015. Then, 228 patients treated with ablation and 228 patients treated with sub-lobotomy were then selected based on propensity score matching. After stratification, matching, and adjustment the Kaplan-Meier analysis was performed to compare the overall survival rates of patients treated with the two procedures.@*RESULTS@#The Kaplan-Meier survival analysis showed that there is a significant difference between the ablation group and the sub-lobectomy group (P<0.05). In the univarlable analysis, the hazard ratio (HR) of sub-lobotomy group was 0.571 (95%CI: 0.455-0.717) compared with the ablation group. Patients treated with sub-lobectomy had a 0.571 times greater risk of adverse outcomes than those treated with ablation. In the multivariable analysis, the HR for sub-lobectomy group was 0.605 (95%CI: 0.477-0.766) compared with the ablation group. Patients treated with sub-lobectomy had a 0.605 time greater risk of adverse outcomes than those treated with ablation. The results suggested that the overall survival rate of patients with stage Ia NSCLC treated with sub-lobotomy was higher than that of patients treated with ablation.@*CONCLUSIONS@#This study suggests that there is a significant difference in overall survival of stage Ia NSCLC patients treated with ablation and with sub-lobotomy. Patients treated with sub-lobotomy for stage Ia NSCLC had higher overall survival than those treated with ablation.
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Objective:The extensive development of anatomical pulnonary segmentectomy requires thoracic surgeons to be familiar with the anatomical variations of the lung segment. The purpose of this study is to analyze the anatomical patterns of the right upper lobe lung segment using three-dimensional reconstruction, and to count rare variant types.Methods:From October 2017 to March 2020, 101 patients with small pulmonary nodules who were undergo segmental resection in our center were subjected to preoperative three-dimensional reconstruction of the lung structure, and the reconstruction data was retained for the statistics and analysis of the anatomical structure in the right upper lung lobe.Results:The right upper lobe bronchus is the most common with three branches(77/101), followed by two branches(16/101) and four branches(7/101). The two branches(70/101) of the right upper lobe pulmonary artery are the most common, followed by single branch(19/101) and three branches(11/101). In rare cases, four branches(1/101 cases) can be seen. The two branches(63/101) of the right upper pulmonary vein were the most common, followed by three branches(32/101) and single branch(6/101). In addition, a total of 12 rare mutations were counted. There were 2 variants in the bronchus, totaling 2 cases; 4 rare variants in the pulmonary artery, 13 cases total; 6 rare variants in the pulmonary vein, 10 cases total.Conclusion:The lung anatomy is complex and has many variations. The surgeon should fully grasp the anatomical structure of the lung segment of the patient's operating area before surgery, the data in this article will be a valuable reference for thoracic surgeons to carry out the upper right lobe segmentectomy.
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Objective To evaluate the application of panning axial turnover in placement of surgical positions before thoracic surgery. Methods From June 2017 to September 2017, altogether 140 patients who underwent thoracic surgery were enrolled in and randomly divided into two groups: the observation group and the control group. The control group was treated with traditional turnover method, while the observation group were treated with axial turnover. Results No significant changes were found in blood pressure, heart rate and respiratory rate (P>0.05) after turning over. There was no significant difference between the observation group and the control group about turn over time, (7.06 ± 0.78)s vs. (7.01±0.81)s (P>0.05). The subjective evaluation results of the medical staff in the observation group were significantly better than those of the control group (Z=-7.111, P<0.01) and the shift rate of double-lumen endotracheal tube in the observation group was 3.7% (2/54), which was significantly lower than 21.6% (11/51) of the control group (χ2=6.158, P<0.05). Conclusions The panning axial turnover properly guided the turn-over work with the principle of human body mechanics, which was more labor-saving and requires less operators. Besides, the panning axial turnover effectively reduced the double- lumen tracheal intubation shift rate. It′s worthy of clinical promotion.
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OBJECTIVE@#To investigate the expression of 2-type small conductance-Ca-activating-K (SK2) channel protein in hypertensive rat myocardial cells.@*METHODS@#Twelve healthy adult male SD rats were randomly divided into control group (n=5) and experimental group (n=7). The rats of experimental group were injected intraperitoneally with N'-nitro-L-arginine (L-NNA 15 mg/(kg·d))while the rats of control group were injected intraperitoneally with isometrical normal saline(15 ml/(kg·d )). The body weight, blood pressure and electrocardiogram of the rats were measured every week. After 4 weeks, the rats were sacrificed to obtain hearts, and the expression of SK2 channel protein in myocardium was detected by Western blot.@*RESULTS@#After 4 weeks of administration, compared with the control group, the blood pressure in the experimental group was significantly elevated (P＜0.05), QRS duration and R-R interval were prolonged, and the expressions of SK2 channel in the atrial and ventricular tissue of the experimental group were significantly higher than those in the control group (1.12±0.18,1.64±0.26, P ＜ 0.05).@*CONCLUSION@#The expressions of atrial and ventricular SK2 pathway are increased in hypertensive model rats. It may be one of the mechanism leading to arrhythmias in hypertensive model rats and can provide new ideas and strategies for the treatment and prognosis of hypertensive diseases.
Subject(s)
Animals , Male , Rats , Hypertension , Metabolism , Myocardium , Metabolism , Protein Serine-Threonine Kinases , Metabolism , Random Allocation , Rats, Sprague-Dawley摘要
Objective@#To evaluate the application of panning axial turnover in placement of surgical positions before thoracic surgery.@*Methods@#From June 2017 to September 2017, altogether 140 patients who underwent thoracic surgery were enrolled in and randomly divided into two groups: the observation group and the control group. The control group was treated with traditional turnover method, while the observation group were treated with axial turnover.@*Results@#No significant changes were found in blood pressure, heart rate and respiratory rate (P>0.05) after turning over. There was no significant difference between the observation group and the control group about turn over time, (7.06±0.78)s vs. (7.01±0.81)s (P>0.05). The subjective evaluation results of the medical staff in the observation group were significantly better than those of the control group (Z=-7.111, P<0.01) and the shift rate of double-lumen endotracheal tube in the observation group was 3.7% (2/54), which was significantly lower than 21.6% (11/51) of the control group (χ2=6.158, P<0.05).@*Conclusions@#The panning axial turnover properly guided the turn-over work with the principle of human body mechanics, which was more labor-saving and requires less operators. Besides, the panning axial turnover effectively reduced the double-lumen tracheal intubation shift rate. It′s worthy of clinical promotion.
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Objective To explore the expression of RIP2 in colorectal cancer(CRC)tissues,and the inva-sion and migration was observed after RIP2 was increased in CRC cell line.Methods 48 cases of CRC paraf-fin-embedded specimens and 56 cases of tumor-adjacent tissues were collected,and expressions of RIP2 was tested by immunohistochemistry(IHC).pEGFP-RIP2 plasmid and JetPRIME were employed to increase the RIP2 in SW480 cells,and variety of invasion and migration was tested in SW480 cells.Results It was showed that expressions of RIP2 was lower in CRC tumors than in tumor-adjacent tissues(P<0.05).After RIP2 in-creased,migration ability of SW480 cells weakened.Conclusion The expression of RIP2 was decreased in CRC tissues,and it was closely related to tumor cell's invasion and metastasis.
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Objective To explore the effects of intensive therapy program on gross motor function of children with spastic cerebral palsy. Methods Thirty 3-15 year old children with spastic cerebral palsy and level I-III in gross motor function classification system (GMFCS) were randomly divide into 2 groups. The trial group adopted intensive therapy program for treatment, including functional dynamic suit and universal exercise unit combined with functional movement training. The control group adopted core stability training for treatment. Children in two groups took a 1-month training program for 3 hours per day and 5 days per week. The pediatric evaluation of gross motor function measure (GMFM-66) and peabody developmental motor scale (PDMS-2) were administered before and after treatment. Results The scores of GMFM-66 as well as the stationary and locomotion scores of PDMS-2 in both groups showed significant differences within group (P<0.01) after treatment. For the scores of GMFM and PDMS-2 between two groups, no significant differences were found. Conclusions The intensive therapy program can improve the gross motor function of children with spastic cerebral palsy and gain the same effects as core stability training, which can provide a novel and effective intervention for children with cerebral palsy.
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Objective To explore the effects of intensive therapy program on gross motor function of children with spastic cerebral palsy.Methods Thirty 3-15 year old children with spastic cerebral palsy and level Ⅰ-Ⅲ in gross motor function classification system (GMFCS) were randomly divide into 2 groups.The trial group adopted intensive therapy program for treatment,including functional dynamic suit and universal exercise unit combined with functional movement training.The control group adopted core stability training for treatment.Children in two groups took a 1-month training program for 3 hours per day and 5 days per week.The pediatric evaluation of gross motor function measure (GMFM-66) and peabody developmental motor scale (PDMS-2) were administered before and after treatment.Results The scores of GMFM-66 as well as the stationary and locomotion scores of PDMS-2 in both groups showed significant differences within group (P ＜ 0.01) after treatment.For the scores of GMFM and PDMS-2 between two groups,no significant differences were found.Conclusions The intensive therapy program can improve the gross motor function of children with spastic cerebral palsy and gain the same effects as core stability training,which can provide a novel and effective intervention for children with cerebral palsy.
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<p><b>OBJECTIVE</b>To observe a turning performance in the rats excited by using a proper electrical stimuli of the barrel cortex region (BC), and the expression of choline acetyltransferase (ChAT) in the BC regions after electoral stimulation.</p><p><b>METHODS</b>SD rats were divided into three groups. The stimulation electrodes were surgically implanted into the bilateral BC regions in the control group and the experimental group rats. The experiment group post surgery for seven days was given the electrical impulses via connection with the electrodes for three times each day through consecutive three days. Three groups of the rats were killed and the brains were quickly removed for frozen sections and then performed with conventional HE and immunohistochemistry staining. And protein samples were prepared from brain and the hippocampus tissues of the three groups to detect the level of the ChAT protein by Western blot.</p><p><b>RESULTS</b>The experimental rats turn left or right when continuously stimulation in the bilateral BC regions with electric pulse. HE staining showed no significant damage around electrodes in the cerebral cortex. Compared with the control and blank groups, the ChAT positive rate in the brain section in the experimental rats was significantly high by immunohistochemistry assay; the level of the ChAT protein in the rats given the electrical stimulation increased.</p><p><b>CONCLUSION</b>Turnings performance of the rat could be initiated hy electrical stimuli in the BC region. Expression of ChAT is significantly higher in the BC regions of rat under electrical stimulation, suggesting that acetylcholine might be associated with signal transmission between senses and movement behavior in the nervous central system.</p>
Subject(s)
Animals , Rats , Acetylcholine , Metabolism , Cerebral Cortex , Metabolism , Choline O-Acetyltransferase , Metabolism , Electric Stimulation , Rats, Sprague-Dawley摘要
Objective To explore the efficacy and safety of low-dose ketamine for prevention of shivering during cesarean section under subarachnoid space and epidural anesthesia.Methods Ninety pregnant women who scheduled cesarean delivery under subarachnoid space and epidural anesthesia were randomized divided into three groups:control group (30 patients) low-dose ketamine group (30 patients) and high-dose ketamine group (30 patients).0.9％ sodium chloride,0.25 mg/kg(3 ml),and 0.50 mg/kg (3 ml) ketamine were given in three groups before operation.The incidence of shivering and adverse effect were recorded respectively before anesthesia,after anesthesia 15 min and 30 min and after operation 1 h.Results The level of mean arterial pressure (MAP) in control group after anesthesia 15 main and 30 min and after operation 1 h[(62 ± 10),(58 ± 8),(61 ± 11) mm Hg(1 mm Hg =0.133 kPa)] were significantly lower than those in high-dose ketamine group [(78 ± 12),(82 ± 8),(76 ± 11)mm Hg] and low-dose ketamine group [(72 ± 10),(76 ± 6),(80 ± 7) mm Hg],there was significant difference (P ＜ 0.05).There was no shivering need treat in low-dose ketamine group and high-dose ketamine group.The rate of hallucinations and nystagmus in low-dose ketamine group [0,6.7％ (2/30)] was significantly lower than that in high-dose ketamine group [20.0％ (6/30),50.0％ (15/30)],there was significant difference (P ＜ 0.05).Conclusion The pretreatment with low-dose ketamine on shivering during cesarean section under subarachnoid space and epidural anesthesia has better preventive effectiveness,0.25 mg/kg of ketamine is more effective than 0.50mg/kg.
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<p><b>OBJECTIVE</b>To observe the role of NB127914, a CRF R1 receptor antagonist, in the regulation of neonatal sleep/wake cycle.</p><p><b>METHODS</b>Rat pups were surgically implanted with electrodes at postnatal day(PN) 13. At PN 14, 6 hours polysomnographic recording data were continuously collected before and after administration of various doses of NBI 27914, atropine and the same amount of saline.</p><p><b>RESULTS</b>Compared with baseline, rapid eye movement (REM) sleep was significantly reduced and was replaced primarily by non-REM (NREM) sleep in all groups treated with NBI, but not with dimethyl sulfoxide/saline. Atropine suppressed REM sleep significantly and increased wakefulness simultaneously.</p><p><b>CONCLUSION</b>Blockage of corticotropin-releasing factor (CRF) R1 receptors deprives neonatal rat REM sleep.</p>