Rectal culture could predict carbapenem-resistant organism bloodstream infection and reduce the mortality in haematological patients: A retrospective cohort study.

OBJECTIVES: The objective is to explore the correlation between rectal swab culture and the overall 30-d survival of hematologic patients diagnosed with carbapenem-resistant organism (CRO) bloodstream infection. METHODS: A total of 434 haematological patients who were complicated with Gram-negative bacilli (GNB) bloodstream infections (BSIs) caused by Gram-negative bacteria between January 2020 and December 2021 were included in our retrospective study. Based on their drug susceptibility results, we classified patients into CRO BSIs and non-CRO BSIs cases. Through group comparison, to uncover the correlation between the positive screening of rectal swabs and reducing the mortality of CRO BSI in patients with haematological diseases. RESULTS: Among the 434 cases of Gram-negative bacteria bloodstream infection, 96 were identified as carbapenem-resistant bloodstream infection, which consisted of 57 cases of carbapenem-resistant Klebsiella pneumoniae (CR-KP), 19 cases of carbapenem-resistant Pseudomonas aeruginosa (CR-PA), 11 cases of carbapenem-resistant Escherichia coli (CR-CO), 5 cases of carbapenem-resistant Acinetobacter baumannii (CR-AB), and 4 cases of other Enterobacteriaceae. Before the onset of CRO bloodstream infection, rectal swab cultures were conducted on 36 patients, and the positive result rate was 75.0% (27/36), with 20 cases of CR-KP, 6 cases of CR-CO, and one case of carbapenem-resistant Enterobacter cloacae. It was observed that the rectal and blood cultures had matching outcomes in 75.0% of cases. The mortality rate within 30 d for CRO BSIs was 53.1% (51/96), while for carbapenem-resistant Enterobacteriaceae (CRE) BSIs it was 62.5% (45/72). Univariate analysis showed that 30-d mortality was significantly reduced when there were positive rectal culture results preceding bloodstream infection (P < 0.001), as well as preemptive anti-infection treatment (P < 0.001). Multivariate analysis demonstrated that preemptive adjustment to an effective antibiotic regimen, guided by positive rectal culture results, had a significant effect on decreasing 30-d mortality following CRO BSIs (P= 0.002). Furthermore, for the management of CRE BSIs, antibiotic treatments utilising ceftazidime/avibactam (CAV/AVI) may be more beneficial compared to those that use tigecycline (TGC) or polymyxin (PMB). CONCLUSION: CRO BSI, especially CRE BSI, can be life-threatening for those with haematological diseases. Utilising rectal culture can effectively identify CRO strains with high sensitivity and specificity. Adjusting antibiotic treatment based on the preemptive positive rectal culture results may significantly decrease 30-d mortality rates for haematological patients with CRO BSIs.

Biomechanics of extreme lateral interbody fusion with different internal fixation methods: a finite element analysis.

BACKGROUND: Establishing a normal L3-5 model and using finite element analysis to explore the biomechanical characteristics of extreme lateral interbody fusion (XLIF) with different internal fixation methods. METHOD: The L3-5 CT image data of a healthy adult male volunteer were selected to establish a normal lumbar finite element model (M0). The range of motion (ROM) of L3-4 and L4-5, under flexion, extension, left bending, right bending, left rotation, and right rotation, together with L3-4 disc pressure was analyzed. Then the L4-5 intervertebral disc was excised and implanted with a cage, supplemented by different types of internal fixation, including lateral two-hole plate model (M1), lateral four-hole plate model (M2), VerteBRIDGE plating model (M3), lateral pedicle model (M4), posterior unilateral pedicle screw model (M5) and posterior bilateral pedicle screw model (M6). The ROM,the maximum stress value of the cage, and the maximum stress value of the intervertebral disc of L3-4 were analyzed and studied . RESULTS: The ROM of L3-4 and L4-L5 segments in the validation model under various motion states was basically consistent with previous reports. The lumbar finite element model was validated effectively. After XLIF-assisted internal fixation, the range of activity in L3-4 segments of each internal fixation model was greater than that of the normal model under various working conditions, among which the M5、M6 model had the larger range of activity in flexion and extension. After the internal fixation of L4-5 segments, the mobility in M1-M6 was significantly reduced under various motion patterns. In terms of flexion and extension, the posterior pedicle fixation model (M5、M6) showed a significant reduction,followed by M2. The maximal von mises cage stress of M1 was obviously greater than that of other models (except the left bending). Compared with M0, the intervertebral disc stress of M1-M6 at L3-4 segments was increased. CONCLUSIONS: It is recommended that the posterior bilateral pedicle screw model is the first choice, followed by the lateral four-hole plate model for fixation during XLIF surgery. However, it is still necessary to be aware of the occurrence of adjacent segment degeneration (ASD) in the later stage.

Dynamic heterogeneity and collective motion in star polymer melts.

While glass formation of linear chain polymer melts has widely been explored, comparatively little is known about glass formation in star polymer melts. We study the segmental dynamics of star polymer melts via molecular dynamics simulations and examine the cooperative nature of segmental motion in star melts. In particular, we quantify how the molecular architecture of star polymers, i.e., the number of arms and the length of those arms, affects the glass transition temperature Tg, the non-Gaussian nature of molecular displacements, the collective string-like motion of monomers, and the role of chain connectivity in the cooperative motion. Although varying the number of arms f and the molecular mass Ma of the star arms can significantly influence the average star molecular shape, all our relaxation data can be quantitatively described in a unified way by the string model of glass formation, an activated transport model that derives from the Adam-Gibbs model, where the degree of cooperative motion is identified with the average length L of string-like particle exchange motions observed in our simulations. Previous work has shown the consistency of the string model with simulations of linear polymers at constant volume and constant pressure, as well as for thin supported polymer films and nanocomposites with variable polymer-surface interactions, where there are likewise large mobility gradients as in the star polymer melts studied in the present paper.

FoxM1 involvement in astrocyte proliferation after spinal cord injury in rats.

The Forkhead box M1 (FoxM1) protein is a proliferation-associated transcription factor that plays a key role in controlling both the G1/S and G2/M transitions of the cell cycle and regulates transcription of cell cycle genes, including cyclin-dependent kinase inhibitors p27(kip1) and p21(waf1/cip1). The expression levels of FoxM1 directly correlated with the proliferation index, cancer survival, genomic instability rate, and microvessel density, and inversely correlated with apoptosis. Furthermore, FoxM1 is determined to play a role in tissue repair following injury in the lungs and liver. However, the signaling of FoxM1, involved in its expression and its role in central nervous system lesion and repair is poorly known. In this study, we performed a spinal cord injury (SCI) model in adult Sprague-Dawley rats and investigated the dynamic changes and role of FoxM1 expression in the spinal cord. Western blot analysis revealed that FoxM1 was lowly presented in normal spinal cord. It gradually increased, reached a peak at day 3, and then declined to basal levels at 14 days after spinal cord injury. Immunohistochemistry further confirmed that FoxM1 was expressed at low levels in gray and white matters in normal condition and increased after SCI. Double immunofluorescence staining showed that FoxM1was co-expressed with NeuN (neuronal marker) and GFAP (astrocytic marker), and FoxM1 expression was increased predominantly in astrocytes after injury, which were regenerating axons and largely proliferated after injury. Furthermore, co-immunoprecipitation studies demonstrated increased interactions among FoxM1, Skp2, and p27(kip1) in the spinal cord after injury. Taken together, these results provide new insights into the molecular mechanisms underlying astrocyte proliferation during SCI and suggest that FoxM1 might play crucial roles in CNS pathophysiology after SCI.

FOXO3a/p27kip1 expression and essential role after acute spinal cord injury in adult rat.

FOXO3a (Forkhead Class box O3a), as an important direct target of the phosphatidylinositol 3-kinase (PI3K)/protein B (Akt) pathway, which regulates the cell survival and the cell-cycle progression. Recent reports showed that FOXO3a could inhibit cell-cycle progression at the G1/S transition by controlling transcription of the cyclin-dependent kinase inhibitor p27(kip1) , which is also a key regulator of the mammalian neurogenesis. To elucidate the expression and role of FOXO3a in nervous system lesion and repair, we performed an acute spinal cord contusion injury (SCI) model in adult rats, which showed a temporal-spatial expression pattern of FOXO3a. Temporally, FOXO3a protein level significantly reduced day 3 after injury, and following FOXO3a down-regulation, p27(kip1) protein and mRNA levels were also decreased after injury. Spatially, decreased levels of FOXO3a and p27(kip1) were predominant in astrocytes, which were regenerating axons and largely proliferated after injury. Furthermore in vitro, Western blot analysis, RT-PCR, and immunofluorescence staining analysis demonstrated the relationship between FOXO3a and p27(kip1) in primary astrocytes. FOXO3a modulated the cell cycle by transcriptional regulation of p27(kip1) in astrocytes. Administration of the PI3K pharmacological inhibitor LY294002 abrogated this effect by regulating FOXO3a and p27(kip1) expression and subcellular localization. These results suggest that decreased levels of FOXO3a and p27(kip1) in spinal cord are involved in axonal regeneration and the proliferation of glial cells after SCI.