Clinical features, microbial spectrum, and antibiotic susceptibility patterns of spontaneous bacterial peritonitis in cirrhotic patients.

BACKGROUND AND AIMS: The microbial spectrum and antimicrobial resistance patterns change over time and vary across regions in patients with spontaneous bacterial peritonitis (SBP). There is an urgent need to clarify the factors associated with in-hospital mortality in these patients. METHODS: In this study, 377 patients with SBP and 794 patients with bacterascites were analyzed for the microbial spectrum, antimicrobial resistance profiles, and laboratory findings. RESULTS: The most common pathogens were Escherichia coli (96, 25.5%), Staphylococcus epidermidis (55, 14.6%), and Enterococcus faecium (42, 11.1%). Multidrug-resistant (MDR) bacteria comprised 49.7% of gram-positive bacteria (GPB) and 48.8% of gram-negative bacteria (GNB). The most sensitive antibiotics were amikacin (91.5%), meropenem (89.8%) and piperacillin/tazobactam (87.6%). Extensively drug-resistant (XDR) (OR=51.457, p < 0.001), neutrophil count (OR=1.088, p < 0.001), and the model for end-stage liver disease (MELD) score (OR=1.124, p < 0.001) were independent predictive factors of in-hospital mortality in patients with SBP. CONCLUSION: MDR represented nearly half of the bacteria isolated from patients with SBP, of which the high prevalence of extended-spectrum ß-lactamase-producing and Carbapenem-resistant bacteria is concerning. The presence of XDR, higher MELD score, and neutrophil count were independent predictive factors associated with higher in-hospital mortality in patients with SBP, indicating that intensive care should be provided to these patients.

Distinct inflammation-related proteins associated with T cell immune recovery during chronic HIV-1 infection.

Chronic inflammation and T cell dysregulation persist in individuals infected with human immunodeficiency virus type 1 (HIV-1), even after successful antiretroviral treatment. The mechanism involved is not fully understood. Here, we used Olink proteomics to comprehensively analyze the aberrant inflammation-related proteins (IRPs) in chronic HIV-1-infected individuals, including in 24 treatment-naïve individuals, 33 immunological responders, and 38 immunological non-responders. T cell dysfunction was evaluated as T cell exhaustion, activation, and differentiation using flow cytometry. We identified a cluster of IRPs (cluster 7), including CXCL11, CXCL9, TNF, CXCL10, and IL18, which was closely associated with T cell dysregulation during chronic HIV-1 infection. Interestingly, IRPs in cluster 5, including ST1A1, CASP8, SIRT2, AXIN1, STAMBP, CD40, and IL7, were negatively correlated with the HIV-1 reservoir size. We also identified a combination of CDCP1, CXCL11, CST5, SLAMF1, TRANCE, and CD5, which may be useful for distinguishing immunological responders and immunological non-responders. In conclusion, the distinct inflammatory milieu is closely associated with immune restoration of T cells, and our results provide insight into immune dysregulation during chronic HIV-1 infection.

Alcohol Cessation in Late Life is Associated with Lower Risk of Cognitive Impairment among the Older Adults in China.

OBJECTIVE: Evidence regarding alcohol consumption and cognitive impairment is controversial. Whether cessation of drinking alcohol by non-dependent drinkers alters the risk of cognitive impairment remains unknown. This study prospectively evaluated the potential association between the history of lifetime alcohol cessation and risk of cognitive impairment. METHODS: This study included 15,758 participants age 65 years or older, selected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) that covered 23 provinces in China. Current alcohol use status, duration of alcohol cessation, and alcohol consumption before abstinence were self-reported by participants; cognitive function was evaluated using Mini-mental State Examination (MMSE). Cause-specific hazard models and restricted cubic splines were applied to estimate the effect of alcohol use on cognitive impairment. RESULTS: Among the 15,758 participants, mean (± SD) age was 82.8 years (± 11.9 years), and 7,199 (45.7%) were males. During a mean of 3.9 years of follow-up, 3,404 cases were identified as cognitive impairment. Compared with current drinkers, alcohol cessation of five to nine years [adjusted HR, 0.79 (95% CI: 0.66-0.96)] and more than nine years [adjusted HR, 0.82 (95% CI: 0.69-0.98)] were associated with lower risk of cognitive impairment. CONCLUSION: A longer duration of alcohol cessation was associated with a lower risk of cognitive impairment assessed by MMSE. Alcohol cessation is never late for older adults to prevent cognitive impairment.

Immune Dysfunctions of CD56neg NK Cells Are Associated With HIV-1 Disease Progression.

Background: Populations of natural killer cells lacking CD56 expression [CD56neg natural killer (NK) cells] have been demonstrated to expand during human immunodeficiency virus (HIV)-1 infection. However, their phenotypic and functional characteristics have not been systematically analyzed, and their roles during disease progression remain poorly understood. Methods: In this study, 84 donors, namely 34 treatment-naïve HIV-1-infected patients (TNs), 29 HIV-1-infected patients with successful antiretroviral therapy (ARTs), and 21 healthy controls (HCs), were enrolled. The phenotypic and functional characteristics of CD56neg NK cells were analyzed using single-cell RNA-sequencing (scRNA-seq) and flow cytometry. A potential link between the characteristics of CD56neg NK cells and the clinical parameters associated with HIV-1 disease progression was examined. Results: The frequency of the CD56neg NK cell population was significantly increased in TNs, which could be partially rescued by ART. Flow cytometry analyses revealed that CD56neg NK cells were characterized by high expression of CD39, TIGIT, CD95, and Ki67 compared to CD56dim NK cells. In vitro assays revealed reduced IFN-γ and TNF-α secretion, as well as decreased expression of granzyme B and perforin in CD56neg NK cells. In line with the data obtained by flow cytometry, scRNA-seq analysis further demonstrated impaired cytotoxic activities of CD56neg NK cells. Notably, a negative correlation was observed between CD39, CD95, and Ki67 expression levels in CD56neg NK cells and CD4+ T cell counts. Conclusions: The results presented in this study indicate that the CD56neg NK cell population expanded in HIV-1-infected individuals is dysfunctional and closely correlates with HIV-1 disease progression.

Trends in the Incidence of Activities of Daily Living Disability Among Chinese Older Adults From 2002 to 2014.

BACKGROUND: Evidence of the trend of the incidence of activities of daily living (ADL) disability among Chinese older people is limited. We aimed to investigate the time trends and potential risk factors for the incidence of ADL disability among Chinese older people (≥65 years). METHODS: We established two consecutive and nonoverlapping cohorts (6,857 participants in the 2002 cohort and 5,589 participants in the 2008 cohort) from the Chinese Longitudinal Healthy Longevity Survey. ADL disability was defined as the need for assistance with at least one essential activity (dressing, bathing, toileting, eating, indoor activities, and continence). Cox proportional hazards models were used to identify factors associated with the trend in the incidence of ADL disability from 2002 to 2014. RESULTS: The incidence (per 1,000 person-years) of ADL disability decreased significantly from 64.2 in the 2002 cohort to 46.6 in the 2008 cohort (p < .001), and decreasing trends in the incidence of ADL disability were observed for all sex, age, and residence subgroups (all p < .001), even after adjusting for multiple potential confounding factors. Moreover, we found that adjustment for sociodemographic, lifestyle information, and cardiovascular risk factors (hypertension, diabetes, heart disease, and stroke) explained less of the decline in ADL disability during the period from 2002 to 2014. CONCLUSION: The incidence of ADL disability among the older adults in China appears to have decreased during the study period, and this finding cannot be explained by existing sociodemographic and lifestyle information and cardiovascular risk factors.

China's Efforts on Management, Surveillance, and Research of Noncommunicable Diseases: NCD Scorecard Project.

BACKGROUND: The incidence of noncommunicable diseases (NCDs) is rising dramatically throughout the world. Aspects of researches concerned with the improvement and development of prevention and control of NCDs have been conducted. Furthermore, the influence of most determinants of the major NCDs has showed that a broad and deep response involving stakeholders in different sectors is required in the prevention and control of NCDs. OBJECTIVE: China has experienced an increase in NCDs in a short period compared with many countries. To address the burden of NCDs in China, it is important to learn about the progress that has been made in prevention and control of NCDs in China and worldwide, informed by opinions of stakeholders in different areas. METHODS: In 2014, GRAND South developed the NCD Scorecard instrument to evaluate progress of NCD prevention and control in 23 countries through a 2-round Delphi process. The scorecard included 51 indicators in 4 domains: governance, surveillance and research, prevention and risk factors, and health system response. Stakeholders were then selected in the areas of government, nongovernmental organizations, private sectors, and academia to join the NCD Scorecard survey. Indicators of progress were scored by stakeholders from 0 (no activity), 1 (present but not adequate), and 2 (adequate) to 3 (highly adequate) and then the percentage of progress in each domain was calculated, representing the current situation in each country. FINDINGS: There were 14 indicators in the domains of governance and surveillance and research. Of 429 stakeholders worldwide, 41 in China participated in the survey. China scored in the top 5 out of all participating countries in those 2 domains, scoring 67% in governance and 64% in surveillance and research. Indicators on which China scored particularly well included having a well-resourced unit or department responsible for NCDs, having a strong national system for recording the cause of all deaths, and having a system of NCD surveillance. Areas where China had the greatest need for improvement included increasing taxes on tobacco and addressing the needs of the population older than age 70 dying from major NCDs. CONCLUSION: In China the burden of disease of NCDs and disabilities remains serious, although China has put significant efforts into its governance and surveillance and research. To improve, further action is needed on reducing tobacco consumption, increasing investment in the national health budget, and increasing the focus on system construction.

Effectiveness of Adherence to Standardized Hypertension Management by Primary Health Care Workers in China: a Cross-sectional Survey 3 Years after the Healthcare Reform.

The standardized hypertension management provided by primary health care workers is an important part of China's recent health care reform efforts. Investigating 5,116 hypertensive patients from a cross-sectional survey conducted by the Chinese Center for Disease Control and Prevention in 2012, this study found that adherence to standardized hypertension management is associated with positive effects on hypertension- related knowledge, healthy lifestyle behavior, antihypertensive medical treatments, and blood pressure control. It will be necessary to provide primary health care workers with sufficient training and reasonable incentives to ensure the implementation and effectiveness of hypertension management.