Epidemiological, clinical and microbiological characteristics of patients with biliary tract diseases with positive bile culture in a tertiary hospital.

PURPOSE: The prevalence of biliary tract diseases, which are common gastrointestinal disorders, is steadily rising. If it progresses to sepsis or septic shock, it can endanger the patient's life. Therefore, it is crucial to promptly diagnose bacterial infection in individuals suffering from biliary diseases and comprehend the risk factors associated with infection. The objective of this study was to examine the types of bacteria present in the bile of patients with biliary tract diseases, assess any alterations in their susceptibility to antimicrobial agents, and identify the risk factors contributing to the development of infection in these patients. PATIENTS AND METHODS: From June 2019 to November 2022, 317 patients of biliary tract diseases with positive bile culture were included in this hospital-based descriptive analysis. The hospital's computerized medical records were used to collect data on demographic information (including gender, age, and occupation), laboratory, and clinical findings, physical examination results, comorbidities, basic diseases, treatment history, complications, and in-hospital outcomes. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) principles. RESULTS: Of the 317 patients with positive biliary tract diseases, 247 had benign diseases and 70 had malignant diseases. Patients with benign disease experienced a higher prevalence of statistically significant symptoms such as abdominal pain (81.4% vs. 57.1%, P = 0.000), nausea (31.2% vs. 14.3%, P = 0.005), vomiting (30.0% vs. 12.9%, P = 0.004), and chills (10.9% vs. 2.9%, P = 0.039), while jaundice (12.6% vs. 37.1%, P = 0.000) was more common in patients with malignant disease. At the species level, Escherichia coli (105; 40.5%), Klebsiella pneumoniae (41; 15.8%), and Pseudomonas aeruginosa (30; 11.6%) were the most commonly found Gram-negative bacterial strains in biliary tract infection. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa were most susceptible to tigecycline, ertapenem and ceftazidime/avibactam, respectively. CONCLUSION: Gram-negative bacteria are the most commonly isolated biliary bacteria. Clinical doctors should pay attention to patients with malignant diseases with low hemoglobin, high total bilirubin and high alkaline phosphatase. Carbapenems, tigecycline, and minocycline are the recommended antibiotics for Enterobacteriaceae. In recent years, the proportion of enterococcus has gradually increased, and clinical attention should be paid to enterococcus infection. Linezolid and vancomycin were recommended for the treatment of Enterococci infections. Overall, this work can provide reference for clinical diagnosis, treatment and effective interventions.

Exposure to cigarette taxes as a teenager and the persistence of smoking into adulthood.

Are teenage and adult smoking causally related? Recent anti-tobacco policy is predicated on the assumption that preventing teenagers from smoking will ensure that fewer adults smoke, but direct evidence in support of this assumption is scant. Using data from three nationally representative sources and instrumenting for teenage smoking with cigarette taxes experienced at ages 14-17, we document a strong positive relationship between teenage and adult smoking: deterring 10 teenagers from smoking through raising cigarette taxes roughly translates into 5 fewer adult smokers. We conclude that efforts to reduce teenage smoking can have long-lasting consequences on smoking participation and, presumably, health.

A preliminary composite of blood-based biomarkers to distinguish major depressive disorder and bipolar disorder in adolescents and adults.

BACKGROUND: Since diagnosis of mood disorder heavily depends on signs and symptoms, emerging researches have been studying biomarkers with the attempt to improve diagnostic accuracy, but none of the findings have been broadly accepted. The purpose of the present study was to construct a preliminary diagnostic model to distinguish major depressive disorder (MDD) and bipolar disorder (BD) using potential commonly tested blood biomarkers. METHODS: Information of 721 inpatients with an ICD-10 diagnosis of MDD or BD were collected from the electronic medical record system. Variables in the nomogram were selected by best subset selection method after a prior univariable screening, and then constructed using logistic regression with inclusion of the psychotropic medication use. The discrimination, calibration and internal validation of the nomogram were evaluated by the receiver operating characteristic curve (ROC), the calibration curve, cross validation and subset validation method. RESULTS: The nomogram consisted of five variables, including age, eosinophil count, plasma concentrations of prolactin, total cholesterol, and low-density lipoprotein cholesterol. The model could discriminate between MDD and BD with an area under the ROC curve (AUC) of 0.858, with a sensitivity of 0.716 and a specificity of 0.890. CONCLUSION: The comprehensive nomogram constructed by the present study can be convenient to distinguish MDD and BD since the incorporating variables were common indicators in clinical practice. It could help avoid misdiagnoses and improve prognosis of the patients.

Heterogeneous Cu2O-Au nanocatalyst anchored on wood and its insight for synergistic photodegradation of organic pollutants.

In this study, a Cu2O-Au nanoparticles (NPs) heterojunction catalyst anchored on wood was developed by in situ reduction and hydrothermal treatment, and the properties of the catalyst were systematically characterized. The catalyst exhibited prominent photocatalysis of methyl orange (MO, 0.169 min- 1), and tetracycline (TC, 0.122 min-1) which were degraded completely within 20 min. Even after four recyclings, the efficiency of MO degradation by the catalyst remained at 80%. The natural wood with three-dimensional porous structures acted as a reducing agent and a stabilizer for Au NPs and Cu2O, which helped to maintain high performance and reusability. The presence of Au NPs mediated the light-induced electron transfer and enhanced the absorption of visible light for promoting photocatalytic activity. The intermediates of contaminants within the degradation process were characterized by liquid chromatography-mass spectrometry. Additionally, the photogenerated superoxide radicals and holes were identified by electron spin resonance. Thus, the potential degradation mechanism catalyzed by the Cu2O-Au NPs-wood was proposed. This findings of this study valorizes biomass as a photocatalyst for wastewater remediation.

Immunogenic and diagnostic potential of recombinant apical membrane antigen-1 from Plasmodium malariae.

The apical membrane antigen-1 (AMA-1) is a crucial target for malaria management and prevention strategies. While the immunogenicity of AMA-1 has been extensively studied for Plasmodium falciparum and Plasmodium vivax, there is a notable scarcity of information for Plasmodium malariae. In this study, recombinant PmAMA-1 was expressed in Escherichia coli, and its integrity was confirmed via western blotting and indirect immunofluorescence assays. Immunization of BALB/c mice with rPmAMA-1 emulsified in Freund's adjuvant resulted in significantly elevated specific IgG antibodies, predominantly IgG1. The immune response exhibited Th1, Th2, and Th17 phenotypes, with a notable Th1 bias. Antisera from immunized mice effectively recognized native PmAMA-1 on P. malariae. These results suggest that PmAMA-1 is a promising target for both vaccine development and diagnostic applications for P. malariae infections, offering dual preventive and diagnostic benefits in malaria control.

Hagfish-inspired hydrogel for root caries: A multifunctional approach including immediate protection, antimicrobial phototherapy, and remineralization.

Root caries is the main cause of oral pain and tooth loss in the elderly. Protecting root lesions from environmental disturbances, resisting pathogens, and facilitating remineralization over time are essential for addressing root caries, but are challenging due to the irregular root surface and the complex oral environment. Hagfish secretes slime when facing danger, which converts into gels upon contact with seawater, suffocating the predators. Inspired by hagfish's defense mechanism, a fluid-hydrogel conversion strategy is proposed to establish a mechanical self-regulating multifunctional platform for root caries treatment. The fluid system (silk fibroin-tannic acid-black phosphorene-urea, ST-BP-U), in which urea disrupts the hydrogen bonds between silk fibroin and tannic acid, can easily spread on the irregular root surface and permeate into dentinal tubules. Upon contact with the surrounding water, urea diffuses, prompting the hydrogel re-formation and creating intimate attachments with micromechanical inlay locks. Meanwhile, BP increases the crosslinking of the re-formed hydrogel network, resulting in reinforced cohesion for robust wet adhesion to the tooth root. This process establishes a structured platform for effective antimicrobial phototherapy and dentin remineralization promotion. This water-responsive fluid-hydrogel conversion system adapts to the irregular root surface in the dynamic wet environment, holding promise for addressing root caries. STATEMENT OF SIGNIFICANCE: Root caries bring a heavy burden to the aging society, but the irregular root surface and dynamic moist oral environment always hinder non-surgical therapeutic effects. Here, we propose a water-responsive fluid-hydrogel conversion strategy aimed at mechanical self-regulation on the irregular and wet root interface to construct a functional structural platform. The liquid system (ST-BP-U) that prebreak intermolecular hydrogen bonds can easily spread on irregular surfaces and dentin tubules. When encountering water, hydrogen bonds re-form, and BP increases the crosslinking of the hydrogel formed in situ. Based on this firm wet-adhesion platform, it provides powerful phototherapy effects and promotes dentin remineralization. This fluid-hydrogel conversion system turns the disadvantages of wet environment into advantages, offering a promising strategy for root caries.

Precipitation extremes observed over and around the Taklimakan Desert, China.

The Taklimakan Desert (TD) is the largest desert in China located in the Tarim Basin (TB) in China's arid region. This study is a review of the change in precipitation and its extremes since 1961 and the high-impact extreme precipitation events in 2012-2021, particularly in 2021, with a focus on the TD along with the surrounding oases and mountainous regions.The TB has experienced significantly warmer and wetter trends since 1961, and extreme rainfall has increased significantly in the TD and its surrounding areas during the 2000s. In the TB, the year 2021 was identified as the 4th warmest for 1961-2021, and was remembered for unprecedented extreme events. Three high-impact extreme events that occurred in 2021 are highlighted, including extreme heavy rainfall over Hetian in mid-June. The earliest extreme rainfall event occurred over North Bazhou in early spring, and the strongest heavy snowfall over Baicheng in April. In addition, we also discussed the underlying physical mechanisms of extreme events over the TB and proposed novel perspectives and unresolved questions on the sciences of heavy rainfall in arid regions. Our results provide a reference for the physical mechanism, attribution, and high-resolution modeling of extreme events.

Methodological comparison of bronchoalveolar lavage fluid-based detection of respiratory pathogens in diagnosis of bacterium/fungus-associated pneumonia in critically ill patients.

Background: Bacterium/fungus-associated pneumonia (BAP/FAP) is the prominent cause of high mortality and morbidity with important clinical impacts globally. Effective diagnostic methods and proper specimen types hopefully facilitate early diagnosis of pneumonia and prevent spread of drug-resistant bacteria/fungi among critically ill patients. Methods: In the present study, 342 bronchoalveolar lavage fluid (BALF) samples were collected from critically ill patients with pulmonary infections between November 2020 and March 2021. The BALF materials were comparatively employed to screen BAP/FAP through microscopy, culture, antigenic marker and PCR-based methods. The limit of detection (LOD) of cultures and PCR for bacteria/fungi was determined by serial dilution assays. Specimen slides were prepared with Gram staining for microscopic examinations. Microbial cultures and identifications underwent routine clinical protocols with the aid of mass spectrometry. (1,3)-ß-D-glucan and galactomannan tests with BALF were carried out accordingly. Direct detection of pathogens in BALF was achieved through PCR, followed by sequencing and BLAST in GenBank database for pathogenic identification. The subjects' demographic and clinical characteristics were well evaluated. Results: BAP/FAP was identified in approximately 47% of the subjects by the BALF-based PCR. The PCR-based diagnostic methods showed improved detection performance for fungi with good LOD, but performed similarly for bacteria, when compared to the cultures. There was poor agreement among traditional microscopy, culture and PCR assays for bacterial detections (kappa value, 0.184 to 0.277). For overall bacterial/fungal detections, the microscopy showed the lowest detecting rate, followed by the cultures, which displayed a slightly higher sensitivity than the microscopy did. The sensitivity of PCR was much higher than that of the other means of interest. However, the traditional cultures rather than antigenic marker-based approaches were moderately consistent with the PCR-based methods in fungal species identification, particularly for Candida and Aspergillus spp. Our findings further revealed that the age, length of hospital stay, invasive procedures and cerebral diseases were likely considered as main risk factors for BAP/FAP. Conclusion: Screening for BALF in critically ill patients with suspected pneumonia pertaining high risk factors using combined PCR-based molecular detection strategies would hopefully contribute to early diagnosis of BAP/FAP and improved prognosis of the patients.

Comparative Analysis of Epidemiological and Clinical Characteristics Between Invasive Candida Infection versus Colonization in Critically Ill Patients in a Tertiary Hospital in Anhui, China.

Objective: Invasive infections due to Candida spp. have unique epidemiology, strain distribution, antimicrobial susceptibility, and clinical features. This study aimed to compare and evaluate these characteristic variables between invasive Candida infection and colonization of critically ill patients in local China to potentially improve differential diagnosis and therapy. Methods: A total of 193 critically ill patients were recruited and followed up for the study, and 133 Candida isolates were obtained from invasive Candida-infected or -colonized subjects. The strains were identified to species level through matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry, assisted by DNA sequencing. Candida susceptibility to common antifungals, including azoles, was determined by microbroth ATB Fungus 3 methodology. Azole resistance-related gene sequencing and homologous 3D-structure modeling were employed. Patient demographics and clinical risk factors were documented and comparatively analyzed from the hospital information-management system. Results: Non-C. albicans Candida (56%) principally caused invasive Candida infections, while C. albicans (55.17%) contributed more to Candida colonization in critically ill patients. Additional risk factors exerted significant impact on both Candida cohorts, primarily including invasive interventions, cancers, and concurrent infections in common. Most colonized Candida spp. harbored relatively higher sensitivity to azoles. ERG11 gene mutations of T348A and A1309G, A395T and C461T, and a novel G1193T to our knowledge were identified in azole-resistant C. albicans, C. tropicalis, and C. parapsilosis respectively, and their corresponding homologous 3D-structure modeling was putatively achieved. Conclusion: Distinct epidemiological and clinical characteristics existed between invasive Candida infection and colonization in critically ill patients. Multiple risk factors significantly involved both the Candida cohorts. Colonized Candida exhibited generally higher azole sensitivity than invasively infectious counterparts. ERG11 point mutations had mechanistically potential ties with local Candida resistance to azoles.

Applying Technology Acceptance Model in Online Entrepreneurship Education for New Entrepreneurs.

The present study aims to enrich the research on online entrepreneurship education, improve the level and ability of entrepreneurship services in China, and improve the overall success rate of entrepreneurship. Based on the technology acceptance model (TAM) proposed by researcher Davis, the study explores the application of TAM in online entrepreneurship education for new entrepreneurs. First, new entrepreneurs who are users of the online entrepreneurship education platform are selected as research objects, and then the influence of the four factors are studied, including perceived ease of use, perceived usefulness, classroom self-efficacy, and perceived external control. Finally, the hypothesis proposed is tested. Results show that online entrepreneurship education influences the perceived ease of use of the user and perceived credibility: the quality of the online entrepreneurship education has a positive impact on the user's perceived usefulness, interactivity has a positive influence on perceived ease of use and perceived usefulness, and interactivity positively influences the perceived ease of use of the user and perceived credibility. Perceived usefulness, perceived ease of use, and perceived credibility have a positive impact on the behavioral intention of the users. The proposed TAM provides some technical and theoretical support for the application of TAM in online entrepreneurship education for new entrepreneurs.

The potential habitat of desert locusts is contracting: predictions under climate change scenarios.

Desert locusts are notorious for their widespread distribution and strong destructive power. Their influence extends from the vast arid and semiarid regions of western Africa to northwestern India. Large-scale locust outbreaks can have devastating consequences for food security, and their social impact may be long-lasting. Climate change has increased the uncertainty of desert locust outbreaks, and predicting suitable habitats for this species under climate change scenarios will help humans deal with the potential threat of locust outbreaks. By comprehensively considering climate, soil, and terrain variables, the maximum entropy (MaxEnt) model was used to predict the potential habitats of solitary desert locusts in the 2050s and 2070s under the four shared socioeconomic pathways (SSP126, SSP245, SSP370, and SSP585) in the CMIP6 model. The modeling results show that the average area under the curve (AUC) and true skill statistic (TSS) reached 0.908 ± 0.002 and 0.701, respectively, indicating that the MaxEnt model performed extremely well and provided outstanding prediction results. The prediction results indicate that climate change will have an impact on the distribution of the potential habitat of solitary desert locusts. With the increase in radiative forcing overtime, the suitable areas for desert locusts will continue to contract, especially in the 2070s under the SSP585 scenario, and the moderately and highly suitable areas will decrease by 0.88 × 106 km2 and 1.55 × 106 km2, respectively. Although the potentially suitable area for desert locusts is contracting, the future threat posed by the desert locust to agricultural production and food security cannot be underestimated, given the combination of maintained breeding areas, frequent extreme weather events, pressure from population growth, and volatile sociopolitical environments. In conclusion, methods such as monitoring and early warning, financial support, regional cooperation, and scientific prevention and control of desert locust plagues should be further implemented.

Facile Fabrication of Three-Dimensional Fusiform-Like α-Fe2O3 for Enhanced Photocatalytic Performance.

α-Fe2O3 fusiform nanorods were prepared by a simple hydrothermal method employing the mixture of FeCl3·6H2O and urea as raw materials. The samples were examined by X-ray diffraction (XRD), high-resolution transmission electron microscopy (HRTEM), scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy and UV-vis diffuse reflectance spectra (UV-DRS). Its visible-light photocatalytic performances were evaluated by photocatalytic decolorization methylene blue (MB) in visible light irradiation. It was found that pure phase α-Fe2O3 nanorods with a length of about 125 nm and a diameter of 50 nm were successfully synthesized. The photocatalytic decolorization of MB results indicated that α-Fe2O3 nanorods showed higher photocatalytic activity than that of commercial Fe2O3 nanoparticles-these are attributed to its unique three-dimensional structure and lower electron-hole recombination rate.