[Observation on the efficacy of continuous veno-venous hemodia-filtration combined with hemoperfusion HA380 in the treatment of 15 cases of heat stroke with multiple organ dysfunction syndrome].

OBJECTIVE: To investigate the clinical efficacy of continuous veno-venous hemodia-filtration (CVVHDF) combined with hemoperfusion (HP) HA380 in the treatment of heat stroke patients with multiple organ dysfunction syndrome (MODS). METHODS: A retrospective and observational study was conducted. A total of 15 patients with heat stroke combined with MODS who were admitted to the department of intensive care unit (ICU) of Suizhou Central Hospital/Hubei University of Medicine from July to September 2022 were selected as the study objects. All 15 patients were treated with CVVHDF combined with HA380 based on the comprehensive management strategy for severe illness. Organ function indicators [including total bilirubin (TBil), aspartate aminotransferase (AST), creatine kinase (CK), lactate dehydrogenase (LDH), creatinine (Cr), cardiac troponin T (cTnT), myoglobin (Myo), MB isoenzyme of creatine kinase (CK-MB), sequential organ failure assessment (SOFA)] and inflammatory indicators [including white blood cell count (WBC), neutrophil count (NEU), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6)] were collected. The improvements of the above indexes at admission, after the first HP, after the second HP, after the third HP, and on the 5th day of treatment were compared. Combined with the clinical outcome of patients, the comprehensive efficacy of CVVHDF combined with HA380 in the treatment of severe heat radiation disease was evaluated. RESULTS: There were 10 males and 5 females among the 15 patients. The average age was (64.5±11.5) years old. There were 6 cases of classical heat stroke and 9 cases of exertional heat stroke. Glasgow coma scale (GCS) was 3-8 at admission; SOFA score was 9-17 within 12 hours after admission; acute physiology and chronic health evaluation II (APACHE II) was 25-45 within 24 hours after admission. After treatment, the IL-6 level and SOFA score gradually decreased, and there were significant differences in the decrease after the second HP compared to admission [IL-6 (ng/L): 48.37 (15.36, 113.03) vs. 221.90 (85.87, 425.90), SOFA: 8.3±3.3 vs. 11.1±2.4, both P < 0.05]. The PCT level reached its peak after the first HP [12.51 (6.07, 41.65) µg/L], and then gradually decreased, and the difference was statistically significant after the third HP [1.26 (0.82, 5.40) µg/L, P < 0.05]. Compared those at admission, Cr level significantly improved after the first HP (µmol/L: 66.94±25.57 vs. 110.80±31.13, P < 0.01), Myo significantly decreased after the second HP [µg/L: 490.90 (164.98, 768.05) vs. 3 000.00 (293.00, 3 000.00), P < 0.05], After the third HP, the CK level also showed significant improvement [U/L: 476.0 (413.0, 922.0) vs. 2 107.0 (729.0, 2 449.0), P < 0.05]. After CVVHDF combined with 3 times HP treatment, the patient's inflammatory response was gradually controlled and organ function gradually recovered. On the 5th day of the disease course, WBC, PCT and IL-6 levels were significantly improved compared to admission, and AST, CK, LDH, Cr, Myo, CK-MB, and SOFA score were significantly corrected compared with those on admission. The 24-hour survival rate of 15 patients was 86.67%, and the 24-hour, 7-day and 28-day survival rates were both as high as 73.33%. The average mechanical ventilation time of 11 surviving patients was (101.8±22.0) hours, the average continuous renal replacement therapy (CRRT) time was (58.8±11.0) hours, the average length of ICU stay was (6.3±1.0) days, and the average total hospitalization was (14.6±5.2) days. CONCLUSIONS: CVVHDF combined with HP HA380 in the treatment of heat stroke patients with MODS can effectively improve organ function and alleviate the inflammatory storm, which is an effective means to improve the rescue rate and reduce the mortality of severe heat stroke patients.

Receptor Plants Alleviated Allelopathic Stress from Invasive Chenopodium ambrosioides L. by Upregulating the Production and Autophagy of Their Root Border Cells.

Chenopodium ambrosioides L. is an invasive plant native to the Neotropics that has seriously threatened the ecological security of China, and allelopathy is one of the mechanisms underlying its successful invasion. Maize (Zea mays L.) and soybean (Glycine max (L.) Merr.), as the main food crops, are usually affected by C. ambrosioides in their planting areas. The purpose of this study was to investigate the ultrastructure, autophagy, and release-related gene expression of receptor plant root border cells (RBCs) after exposure to volatile oil from C. ambrosioides and its main component α-terpene, which were studied using maize and soybean as receptor plants. The volatiles inhibited root growth and promoted a brief increase in the number of RBCs. As the volatile concentration increased, the organelles in RBCs were gradually destroyed, and intracellular autophagosomes were produced and continuously increased in number. Transcriptomic analysis revealed that genes involved in the synthesis of the plasma membrane and cell wall components in receptor root cells were significantly up-regulated, particularly those related to cell wall polysaccharide synthesis. Meanwhile, polygalacturonase and pectin methylesterases (PME) exhibited up-regulated expression, and PME activity also increased. The contribution of α-terpene to this allelopathic effect of C. ambrosioides volatile oil exceeded 70%. Based on these results, receptor plant root tips may increase the synthesis of cell wall substances while degrading the intercellular layer, accelerating the generation and release of RBCs. Meanwhile, their cells survived through autophagy of RBCs, indicating the key role of RBCs in alleviating allelopathic stress from C. ambrosioides volatiles.

Application of the Electromagnetic Method to the Spatial Distribution of Subsurface Saline and Fresh Water in the Coastal Mudflat Area of Jiangsu Province.

Interfacial zones straddling terrestrial and marine realms, colloquially known as mudflats, epitomize a dynamic nexus between these environments and are fundamental to the coastal ecosystem. The investigation of these regions is paramount for facilitating infrastructural developments including ports, wharfs, cross-sea bridges, and the strategic utilization of freshwater resources sequestered from mainland islands amid ongoing economic progress. Terrestrial realms conventionally employ electromagnetic techniques as efficacious modalities to delineate subterranean geological information, encompassing structural details and water-bearing strata. However, the peculiar topographic and geological nuances of mudflat regions pose substantial challenges for the efficacious application of electromagnetic methodologies. The present paper endeavors to address these challenges by suggesting innovative modifications to the existing instrumentation and evolving novel data acquisition techniques specifically tailored for electromagnetic exploration within mudflat environments. This paper delves into the electrical characteristics of water-bearing layers within mudflats, and ascertains details pertaining to the subterranean structure and the spatial distribution of fresh and saline water resources, through the holistic interpretation of a multitude of profiles.

The long-term effect of glutaraldehyde on the bacterial community in anaerobic ammonium oxidation reactor.

A 160-day incubation was performed with two anammox reactors (GA and CK) to investigate the effect of glutaraldehyde. The results indicated that anammox bacteria were very sensitive when glutaraldehyde in GA reactor increased to 40 mg/L, the nitrogen removal efficiency sharply decreased to 11%, only one-quarter of CK. Glutaraldehyde changed spatial distribution of exopolysaccharides, caused anammox bacteria (Brocadia CK_gra75) to disassociate from granules (24.70% of the reads in CK but only 14.09% in GA granules). Metagenome analysis indicated glutaraldehyde led to the denitrifier community succession from strains without nir (nitrite reductase) and nor (nitric oxide reductases) genes to those with them, and the rapid growth of denitrifiers with NodT (an outer membrane factor)-related efflux pumps replacing those with another TolC -related ones. Meanwhile, Brocadia CK_gra75 lacks the NodT proteins. This study provides important insight into community adaptation and potential resistance mechanism in an active anammox community after exposure to disinfectant.

Treatment and utilization of swine wastewater - A review on technologies in full-scale application.

The management of swine wastewater has become the focus of attention in the farming industry. The disposal mode of swine wastewater can be classified as field application of treated waste and treatment to meet discharge standards. The status of investigation and application of unit technology in treatment and utilization such as solid-liquid separation, aerobic treatment, anaerobic treatment, digestate utilization, natural treatment, anaerobic-aerobic combined treatment, advanced treatment, are reviewed from the full-scale application perspective. The technologies of anaerobic digestion-land application is most appropriate for small and medium-sized pig farms or large pig farms with enough land around for digestate application. The process of "solid-liquid separation-anaerobic-aerobic-advanced treatment" to meet the discharge standard is most suitable for large and extra-large pig farms without enough land. Poor operation of anaerobic digestion unit in winter, hard to completely utilize liquid digestate and high treatment cost of digested effluent for meeting discharge standard are established as the main difficulties.

Venous Thrombus Embolism in Polytrauma: Special Attention to Patients with Traumatic Brain Injury.

Venous thrombus embolism (VTE) is common after polytrauma, both of which are considered significant contributors to poor outcomes and mortality. Traumatic brain injury (TBI) is recognized as an independent risk factor for VTE and one of the most common components of polytraumatic injuries. Few studies have assessed the impact of TBI on the development of VTE in polytrauma patients. This study sought to determine whether TBI further increases the risk for VTE in polytrauma patients. A retrospective, multi-center trial was performed from May 2020 to December 2021. The occurrence of venous thrombosis and pulmonary embolism from injury to 28 days after injury was observed. Of 847 enrolled patients, 220 (26%) developed DVT. The incidence of DVT was 31.9% (122/383) in patients with polytrauma with TBI (PT + TBI group), 22.0% (54/246) in patients with polytrauma without TBI (PT group), and 20.2% (44/218) in patients with isolated TBI (TBI group). Despite similar Glasgow Coma Scale scores, the incidence of DVT in the PT + TBI group was significantly higher than in the TBI group (31.9% vs. 20.2%, p < 0.01). Similarly, despite no difference in Injury Severity Scores between the PT + TBI and PT groups, the DVT rate was significantly higher in the PT + TBI group than in the PT group (31.9% vs. 22.0%, p < 0.01). Delayed anticoagulant therapy, delayed mechanical prophylaxis, older age, and higher D-dimer levels were independent predictive risk factors for DVT occurrence in the PT + TBI group. The incidence of PE within the whole population was 6.9% (59/847). Most patients with PE were in the PT + TBI group (64.4%, 38/59), and the PE rate was significantly higher in the PT + TBI group compared to the PT (p < 0.01) or TBI (p < 0.05) group. In conclusion, this study characterizes polytrauma patients at high risk for VTE occurrence and emphasizes that TBI markedly increases the incidence of DVT and PE in polytrauma patients. Delayed anticoagulant therapy and delayed mechanical prophylaxis were identified as the major risk factors for a higher incidence of VTE in polytrauma patients with TBI.

Multifactorial Shock: A Neglected Situation in Polytrauma Patients.

Background: Shock after traumatic injury is likely to be hypovolemic, but different types of shock (distributive shock, obstructive shock, or cardiogenic shock) can occur in combination, known as multifactorial shock. Multifactorial shock is a neglected area of study, and is only reported sporadically. Little is known about the incidence, characteristics, and outcomes of multifactorial shock after polytrauma. Methods: A retrospective, observational, multicenter study was conducted in four Level I trauma centers involving 1051 polytrauma patients from June 2020 to April 2022. Results: The mean Injury Severity Score (ISS) was 31.1, indicating a severely injured population. The most common type of shock in the early phase after polytrauma (≤48 h) is hypovolemic shock (83.2%), followed by distributive shock (14.4%), obstructive shock (8.7%), and cardiogenic shock (3.8%). In the middle phase after polytrauma (>48 h or ≤14 days), the most common type of shock is distributive shock (70.7%), followed by hypovolemic shock (27.2%), obstructive shock (9.9%), and cardiogenic shock (7.2%). Multifactorial shock accounted for 9.7% of the entire shock population in the early phase and 15.2% in the middle phase. In total, seven combinations of multifactorial shock were described. Patients with multifactorial shock have a significantly higher complication rate and mortality than those with single-factor shock. Conclusions: This study characterizes the incidence of various types of shock in different phases after polytrauma and emphasizes that different types of shock can occur simultaneously or sequentially in polytrauma patients. Multifactorial shock has a relatively high incidence and mortality in polytrauma patients, and trauma specialists should be alert to the possibility of their occurrence.

Clinical Efficacy and In Vitro Drug Sensitivity Test Results of Azithromycin Combined With Other Antimicrobial Therapies in the Treatment of MDR P. aeruginosa Ventilator-Associated Pneumonia.

Objective: The aim of the research was to study the effect of azithromycin (AZM) in the treatment of MDR P. aeruginosa VAP combined with other antimicrobial therapies. Methods: The clinical outcomes were retrospectively collected and analyzed to elucidate the efficacy of different combinations involving azithromycin in the treatment of MDR-PA VAP. The minimal inhibitory concentration (MIC) of five drugs was measured by the agar dilution method against 27 isolates of MDR-PA, alone or in combination. Results: The incidence of VAP has increased approximately to 10.4% (961/9245) in 5 years and 18.4% (177/961) caused by P. aeruginosa ranking fourth. A total of 151 cases of MDR P. aeruginosa were included in the clinical retrospective study. Clinical efficacy results are as follows: meropenem + azithromycin (MEM + AZM) was 69.2% (9/13), cefoperazone/sulbactam + azithromycin (SCF + AZM) was 60% (6/10), and the combination of three drugs containing AZM was 69.2% (9/13). The curative effect of meropenem + amikacin (MEM + AMK) was better than that of the meropenem + levofloxacin (MEM + LEV) group, p = 0.029 (p < 0.05). The curative effect of cefoperazone/sulbactam + amikacin (SCF + AMK) was better than that of the cefoperazone/sulbactam + levofloxacin (SCF + LEV) group, p = 0.025 (p < 0.05). There was no significant difference between combinations of two or three drugs containing AZM, p > 0.05 (p = 0.806). From the MIC results, the AMK single drug was already very sensitive to the selected strains. When MEM or SCF was combined with AZM, the sensitivity of them to strains can be significantly increased. When combined with MEM and AZM, the MIC50 and MIC90 of MEM decreased to 1 and 2 ug/mL from 8 to 32 ug/mL. When combined with SCF + AZM, the MIC50 of SCF decreased to 16 ug/mL, and the curve shifted obviously. However, for the combination of SCF + LEV + AZM, MIC50 and MIC90 could not achieve substantive changes. From the FIC index results, the main actions of MEM + AZM were additive effects, accounting for 72%; for the combination of SCF + AZM, the additive effect was 40%. The combination of AMK or LEV with AZM mainly showed unrelated effects, and the combination of three drugs could not improve the positive correlation between LEV and AZM. Conclusion: AZM may increase the effect of MEM or SCF against MDR P. aeruginosa VAP. Based on MEM or SCF combined with AMK or AZM, we can achieve a good effect in the treatment of MDR P. aeruginosa VAP.

Phytochrome interacting factor regulates stomatal aperture by coordinating red light and abscisic acid.

Stomata are crucial valves coordinating the fixation of carbon dioxide by photosynthesis and water loss through leaf transpiration. Phytochrome interacting factors (PIFs) are negative regulators of red light responses that belong to the basic helix-loop-helix family of transcription factors. Here, we show that the rice (Oryza sativa) PIF family gene OsPIL15 acts as a negative regulator of stomatal aperture to control transpiration in rice. OsPIL15 reduces stomatal aperture by activating rice ABSCISIC ACID INSENSITIVE 5 (OsABI5), which encodes a critical positive regulator of ABSCISIC ACID (ABA) signaling in rice. Moreover, OsPIL15 interacts with the NIGT1/HRS1/HHO family transcription factor rice HRS1 HOMOLOG 3 (OsHHO3) to possibly enhance the regulation of stomatal aperture. Notably, we discovered that the maize (Zea mays) PIF family genes ZmPIF1 and ZmPIF3, which are homologous to OsPIL15, are also involved in the regulation of stomatal aperture in maize, indicating that PIF-mediated regulation of stomatal aperture may be conserved in the plant lineage. Our findings explain the molecular mechanism by which PIFs play a role in red-light-mediated stomatal opening, and demonstrate that PIFs regulate stomatal aperture by coordinating the red light and ABA signaling pathways.

N-Acyl-Homoserine Lactone (AHL)-Mediated Microalgal-Bacterial Communication Driving Chlorella-Activated Sludge Bacterial Biofloc Formation.

N-acyl-homoserine lactones (AHLs) as autoinducers of Gram-negative bacteria for quorum sensing regulation have shown positive effects on the production of aromatic proteins in extracellular polymeric substances (EPSs) during bioflocculation. To investigate the role of AHLs in aromatic protein production, a Chlorella-bacteria system with great bioflocculation was established via fed-batch cultivation. Tryptophan and aromatic proteins as the main compounds in the EPS of bioflocs showed an increasing trend during fed-batch cultivation. The Chlorella cells only secreted tryptophan rather than aromatic proteins during axenic cultivation. N-dodecanoyl-l-homoserine lactone (C12-HSL) was correlated with the flocculation activity and extracellular protein content of bioflocs during fed-batch cultivation. The addition of exogenous C12-HSL enhanced the flocculation activity of the Chlorella-bacteria system and aromatic protein production in the EPS. Chlorella cells sensed exogenous C12-HSL and significantly upregulated the aromatic protein synthesis pathway during axenic cultivation. In addition, vanillin as a quorum-sensing inhibitor suppressed the positive effect of C12-HSL on flocculation activity and aromatic protein production and synthesis. This result indicated that vanillin intercepts the response of Chlorella cells to C12-HSL. Overall, C12-HSL is supposed to be an important signal molecule to achieve communication between Chlorella and Gram-negative bacteria and subsequently induce Chlorella cells to produce aromatic proteins for biofloc formation.

Constructed microalgal-bacterial symbiotic (MBS) system: Classification, performance, partnerships and perspectives.

The microalgal-bacterial symbiotic (MBS) system shows great advantages in the synchronous implementation of wastewater treatment and nutrient recovery. To enhance the understanding of different MBS systems, this review summarizes reported MBS systems and proposes three patterns according to the living state of microalgae and bacteria. They are free microalgal-bacterial (FMB) system, attached microalgal-bacterial (AMB) system and bioflocculated microalgal-bacterial (BMB) system. Compared with the other two patterns, BMB system shows the advantages of microalgal biomass harvesting and application. To further understand the microalgal-bacterial partnerships in the bioflocculation of BMB system, this review discusses bioflocs characteristics, extracellular polymeric substances (EPS) properties and production, and the effect of microalgae/bacteria ratio and microalgal strains on the formation of bioflocculation. Microalgal biomass production and application are important for BMB system development in the future. Food processing wastewater characterized by high biodegradability and low toxicity should be conducive for microalgal cultivation. In addition, exogenous addition of functional bacteria for nutrient removal and bioflocculation formation would be a crucial research direction to facilitate the large-scale application of BMB system.

Nitrification performance evaluation of activated sludge under high potassium ion stress during high-ammonia nitrogen organic wastewater treatment.

The recycling reverse osmosis (RO) membrane concentrate of some high-ammonia nitrogen (NH4+-N) organic wastewater to the biological unit could cause potassium ion (K+) accumulation, thereby affecting the removal of NH4+-N by activated sludge. Thus, the effects of high K+ stress on activated sludge nitrification performance was studied. The results showed that the high K+ stress promoted the floc sludge to produce more extracellular polymers (EPS), which accelerated the sludge sedimentation and enriched the biomass in sequential batch reactors (SBRs). The ammonia oxidation process and nitrite (NO2--N) oxidation process were further analyzed in the nitrification process. High K+ stress enriched ammonia oxidizing bacteria (AOB), which ensured the efficient ammonia oxidation process in SBRs, and ensured the removal rate of NH4+-N was maintained above 93%. However, high K+ stress (15g/L KCl) inhibited the activity of NO2--N oxidizing bacteria (NOB) and reduced the abundance of NOB, thus leading to the accumulation of NO2--N, and finally worsened the nitrification performance of activated sludge. In short, the performance of activated sludge will not be inhibited when the K+ in the wastewater does not exceed 5.23 g/L. The results could provide a reference for the optimization of the biological performance in treating high-NH4+-N organic wastewater with activated sludge coupled RO membrane treatment process.

Intermittent air mixing system for anaerobic digestion of animal wastewater: Operating conditions and full-scale validation.

An air mixing system for anaerobic digestion has been proved to be beneficial for methane production. The aim of the present study was to further investigate the appropriate conditions for air mixing. The effective methane production time (EMPT) was defined to determine the air mixing time in the article. The results indicated that the appropriate aeration intensity was 66.7 mL air per volume of reactor per min and mixing time was 1.5 min. When air mixing time exceeded 3 min on each occasion, total CH4 production was less than that achieved under the no mixing condition due to a decrease in the EMPT. In addition, the possibility of air mixing was evaluated in an anaerobic full-scale plant comprising a continuous stirred tank reactor. One year of operating data validated the feasibility of air mixing during the anaerobic digestion of swine wastewater.

NtRBP45, a nuclear RNA-binding protein of Nicotiana tabacum, facilitates post-transcriptional gene silencing.

The tobacco RBP45 is a nuclear RNA binding protein (RBP). In this study, we identified that the gene expression of NtRBP45 was significantly up-regulated upon the Tobacco mosaic virus infection and the central region of the protein accounted for its nuclear localization. In particular, using a green fluorescent protein-based transient suppression assay, we uncovered that the transiently overexpressed NtRBP45 was able to enhance local post-transcriptional gene silencing (PTGS), facilitate siRNA accumulation, and compromise the RNA silencing suppression mediated by Tomato aspermy virus 2b protein. Deletion mutagenesis showed that both the N- and C-terminal regions of NtRBP45 were necessary for enhancing PTGS. The data overall indicated a novel RNA silencing factor that might participate in antiviral defense.

Microalgal interstrains differences in algal-bacterial biofloc formation during liquid digestate treatment.

In this study, the effect of microalgal strains on the formation of algal-bacterial biofloc was investigated in liquid digestate pretreated by a sequencing batch reactor (SBR), which loaded much aerobic bacteria from activated sludge. Six microalgal strains resulted in three cases: no-bioflocculation (Scenedesmus obliquus and Botryococcus braunii), optimal-bioflocculation with high flocculation activity and good growth (Chlorella sp. BWY-1, Haematococcus pluvialis and Dictyosphaerium ehnenbergianum) and over-bioflocculation with high flocculation activity and bad growth (Chlorella vulgaris). Chlorella sp. BWY-1 provided a better level of flocculation activity and growth. Polysaccharides and proteins were present in EPS of algal-bacterial biofloc, and their distribution was confirmed by staining with alcian blue and fluorescein isothiocyanate (FITC).

Simulating the effects of climate change across the geographical distribution of two medicinal plants in the genus Nardostachys.

BACKGROUND: The medicinal plants of Radix et Rhizoma Nardostachyos include Nardostachys jatamansi and N. chinensis. Traditionally, the two plants have been used to treat many diseases. Because of their special aroma, they are also commonly used in the food and cosmetics industry. Recently, N. jatamansi and N. chinensis have been overexploited due to their economic importance, resulting in a sharp decline in their wild resources. Predicting potential distributions of the genus Nardostachys under different climate scenarios and understanding its preferred habitat are of great significance for their conservation, artificial cultivation, and assessment of their value. METHODS: The Maxent model was used to predict the potential geographical distributions of the genus Nardostachys under current and future climatic conditions based on two representative concentration pathways (RCP2.6 and RCP8.5) for the 2050s and 2070s. These data were used to study the effects of climate variables. RESULTS: The results show that the potential distribution of the two species will increase, thus more suitable habitats will be present in China. The suitable habitat for N. chinensis presents a relatively stable growth compared to N. jatamansi. In addition, precipitation plays a crucial role in modeling the effects of climate change on the genus Nardostachys. This study provides theoretical guidance for the cultivation of N. chinensis.

Acinetobacter baumannii Ventilator-Associated Pneumonia: Clinical Efficacy of Combined Antimicrobial Therapy and in vitro Drug Sensitivity Test Results.

Objective: To evaluate therapeutic efficacy of different combined antimicrobial treatments against Acinetobacter baumannii ventilator-associated pneumonia (VAP). Methods: Clinical outcomes were retrospectively analyzed to elucidate the efficacy of four combined antimicrobial regimens. The chessboard and micro broth dilution methods determined the minimum inhibitory concentrations (MICs) of four antiseptic drugs singly used and combined two drugs against 36 isolates of multidrug-resistant (MDR) A. baumannii. Results: The incidence of VAP was approximately 6.9% (237/3424) between January 1, 2015 and December 31, and 35.9% (85/237) of the cases were caused by A. baumannii. Among these cases, 60 belonged to AB-VAP, for whom antimicrobial treatment plan was centralized and clinical data was complete. Moreover, all 60 strains of A. baumannii were MDR bacteria from reports microbiological laboratory. Resistance rate was lowest for amikacin (68.3%) and ampicillin sulbactam (71.7%). Resistance rate for imipenem increased from 63.2 to 90.9% during the 3 years. However, in these 60 cases of AB-VAP, the combination between 4 antibiotics was effective in most cases: the effective rate was 75% (18/24) for sulbactam combined with etilmicin, 71.4% (10/14) for sulbactam combined with levofloxacin, 72.7% (8/11) for meropenem combined with etilmicin, and 63.6% (7/11) for meropenem combined with levofloxacin. There was no statistical difference between four regimens (P > 0.05). Sulbactam combined with etilmicin decreased 1/2 of MIC50 and MIC90 of sulbactam while the decreases in etilmicin were more obviously than single drug. When adopting meropenem combined with levofloxacin or etilmicin, the MIC of meropenem reduced to 1/2 of that in applying single drug. As for sulbactam or meropenem combined with levofloxacin, it also lessened the MIC50 of levofloxacin to 1/2 of that for single drug. FIC results suggested that the effects of four combined antimicrobial regimens were additive or unrelated. When sulbactam was combined with etimicin, the additive effect was 63.89%. Conclusion: Drug combination sensitivity test in vitro may be helpful for choosing antimicrobial treatment plans. Sulbactam or meropenem as the basis of treatment regimens can function as the alternatives against AB-VAP. Sulbactam combined with etimicin has been regarded as a recommended regimen in Suizhou, Hubei, China.

Meropenem and Amikacin for Management of Post-Neurosurgical Infections from Acinetobacter baumannii.

Background: Intra-cranial infection with Acinetobacter baumannii is a tough problem because of the presence of multi-resistance and poor drug penetration through the blood-brain barrier. Such intra-cranial infections can lead to serious complications and death. We retrospectively analyzed the culture results and clinical characteristics of patients with intra-cranial infections in our hospital and suggested intravenous (IV) meropenem and intra-thecal (IT) amikacin therapy may be effective in the management of A. baumannii infection. Case presentation: We reported four cases of post-neuro-surgical A. baumannii intra-cranial infection whose clinical futures were high fever and consciousness disturbance. Our patients were treated successfully with IV meropenem and IT amikacin. Conclusion: We presented our cases of pandrug-resistant A. baumannii intra-cranial infection that was managed successfully with a systemic provision of IV meropenem and IT amikacin. Therefore, these cases exemplify that systemic administration of IV meropenem and IT amikacin can be a good therapeutic option against A. baumannii intra-cranial infection when colistin is not available.

Establishment of stable microalgal-bacterial consortium in liquid digestate for nutrient removal and biomass accumulation.

In this study, a microalgal-bacterial consortium (MBC) was established in liquid digestate (LD) by optimizing sequencing batch reactor (SBR) operating parameters and microalgae inoculation to address the abovementioned challenges. The bacteria from LD SBR-Activated Sludge System effluent under the optimum conditions of 25 °C, 7.0 g/L MLSS, 5 mg/L DO concentration, and 6 h hydraulic retention time with 0.5 mg/L DW Chlorella sp. BWY-1 could form stable MBCs outdoors in an airlift photoreactor. The stable MBC facilitates the continuous removal of nitrogen and phosphorus, promotes the accumulation of biomass and lipids, and contributes to the improvement of the sedimentation. The results from this study provided a new technique for the purification and utilization of LD, more importantly decreasing the environmental threat caused by improperly processed LD.