Carbapenem-resistant Gram-negative bacteria (CR-GNB) in ICUs: resistance genes, therapeutics, and prevention - a comprehensive review.

Intensive care units (ICUs) are specialized environments dedicated to the management of critically ill patients, who are particularly susceptible to drug-resistant bacteria. Among these, carbapenem-resistant Gram-negative bacteria (CR-GNB) pose a significant threat endangering the lives of ICU patients. Carbapenemase production is a key resistance mechanism in CR-GNB, with the transfer of resistance genes contributing to the extensive emergence of antimicrobial resistance (AMR). CR-GNB infections are widespread in ICUs, highlighting an urgent need for prevention and control measures to reduce mortality rates associated with CR-GNB transmission or infection. This review provides an overview of key aspects surrounding CR-GNB within ICUs. We examine the mechanisms of bacterial drug resistance, the resistance genes that frequently occur with CR-GNB infections in ICU, and the therapeutic options against carbapenemase genotypes. Additionally, we highlight crucial preventive measures to impede the transmission and spread of CR-GNB within ICUs, along with reviewing the advances made in the field of clinical predictive modeling research, which hold excellent potential for practical application.

The impact of gene polymorphism and hepatic insufficiency on voriconazole dose adjustment in invasive fungal infection individuals.

Voriconazole (VRZ) is a broad-spectrum antifungal medication widely used to treat invasive fungal infections (IFI). The administration dosage and blood concentration of VRZ are influenced by various factors, posing challenges for standardization and individualization of dose adjustments. On the one hand, VRZ is primarily metabolized by the liver, predominantly mediated by the cytochrome P450 (CYP) 2C19 enzyme. The genetic polymorphism of CYP2C19 significantly impacts the blood concentration of VRZ, particularly the trough concentration (Ctrough), thereby influencing the drug's efficacy and potentially causing adverse drug reactions (ADRs). Recent research has demonstrated that pharmacogenomics-based VRZ dose adjustments offer more accurate and individualized treatment strategies for individuals with hepatic insufficiency, with the possibility to enhance therapeutic outcomes and reduce ADRs. On the other hand, the security, pharmacokinetics, and dosing of VRZ in individuals with hepatic insufficiency remain unclear, making it challenging to attain optimal Ctrough in individuals with both hepatic insufficiency and IFI, resulting in suboptimal drug efficacy and severe ADRs. Therefore, when using VRZ to treat IFI, drug dosage adjustment based on individuals' genotypes and hepatic function is necessary. This review summarizes the research progress on the impact of genetic polymorphisms and hepatic insufficiency on VRZ dosage in IFI individuals, compares current international guidelines, elucidates the current application status of VRZ in individuals with hepatic insufficiency, and discusses the influence of CYP2C19, CYP3A4, CYP2C9, and ABCB1 genetic polymorphisms on VRZ dose adjustments and Ctrough at the pharmacogenomic level. Additionally, a comprehensive summary and analysis of existing studies' recommendations on VRZ dose adjustments based on CYP2C19 genetic polymorphisms and hepatic insufficiency are provided, offering a more comprehensive reference for dose selection and adjustments of VRZ in this patient population.

Tumor microenvironment responsive metal nanoparticles in cancer immunotherapy.

Malignant tumors have a unique tumor microenvironment (TME), which includes mild acidity, hypoxia, overexpressed reactive oxygen species (ROS), and high glutathione (GSH) levels, among others. Recently, TME regulation approaches have attracted widespread attention in cancer immunotherapy. Nanoparticles as drug delivery systems have ability to modulate the hydrophilicity of drugs to affect drug uptake and efflux in tumor. Especially, the metal nanoparticles have been extensive applied for tumor immunotherapy due to their unique physical properties and elaborate design. However, the potential deficiencies of metal nanoparticles due to their low biodegradability, toxicity and treatment side effects restrict their clinical application. In this review, we briefly introduce the feature characteristics of the TME and the recent advances in tumor microenvironment responsive metal nanoparticles for tumor immunotherapy. In addition, nanoparticles could be combined with other treatments, such as chemotherapy, radiotherapy and photodynamic therapy also is presented. Finally, the challenges and outlook for improving the antitumor immunotherapy efficiency, side effect and potential risks of metal nanoparticles has been discussed.

Individualized medication based on pharmacogenomics and treatment progress in children with IgAV nephritis.

Immunoglobulin A vasculitis (IgAV) nephritis, also known as Henoch-Schönlein purpura nephritis (HSPN), is a condition in which small blood vessel inflammation and perivascular IgA deposition in the kidney caused by neutrophil activation, which more often leads to chronic kidney disease and accounts for 1%-2% of children with end-stage renal disease (ESRD). The treatment principles recommended by the current management guidelines include general drug treatment, support measures and prevention of sequelae, among which the therapeutic drugs include corticosteroids, immunosuppressive agents and angiotensin system inhibitors. However, the concentration range of immunosuppressive therapy is narrow and the individualized difference is large, and the use of corticosteroids does not seem to improve the persistent nephropathy and prognosis of children with IgAV. Therefore, individualized maintenance treatment of the disease and stable renal prognosis are still difficult problems. Genetic information helps to predict drug response in advance. It has been proved that most gene polymorphisms of cytochrome oxidase P450 and drug transporter can affect drug efficacy and adverse reactions (ADR). Drug therapy based on genetics and pharmacogenomics is beneficial to providing safer and more effective treatment for children. Based on the pathogenesis of IgAV, this paper summarizes the current therapeutic drugs, explores potential therapeutic drugs, and focuses on the therapeutic significance of corticosteroids and immunosuppressants in children with IgAV nephritis at the level of pharmacogenomics. In addition, the individualized application of corticosteroids and immunosuppressants in children with different genotypes was analyzed, in order to provide a more comprehensive reference for the individualized treatment of IgAV nephritis in children.

Hen raising helps chicks establish gut microbiota in their early life and improve microbiota stability after H9N2 challenge.

BACKGROUND: Early gut microbial colonization is important for postnatal growth and immune development of the chicken. However, at present, commercial chickens are hatched and raised without adult hens, thus are cut off from the microbiota transfer between hens and chicks. In this study, we compared the gut microbiota composition between hen-reared and separately reared chicks, and its impact on the resistance to H9N2 avian influenza virus, with the motive of investigating the impact of this cutoff in microbiota transfer. RESULTS: We used the 16SrRNA sequencing method to assess the composition of the gut microbiota in chicks represented by three hen-reared groups and one separately reared group. We found that the diversity of gut microbes in the chicks from the three hen-reared groups was more abundant than in the separately reared group, both at the phylum and genus levels. Our findings highlight the importance of early parental care in influencing the establishment of gut microbiota in the early life of chicks. SourceTracker analysis showed that the feather and cloaca microbiota of hens are the main sources of gut microbiota of chicks. After H9N2 exposure, the viral infection lasted longer in the separately reared chicks, with the viral titers in their oropharyngeal swabs being higher compared to the hen-reared chicks at day 5 post-infection. Interestingly, our results revealed that the gut microbiota of the hen-reared chicks was more stable after H9N2 infection in comparison to that of the separately reared chicks. CONCLUSIONS: Microbiota transfer between the hens and their chicks promotes the establishment of a balanced and diverse microbiota in the early life of the chicks and improves microbiota stability after H9N2 challenge. These findings advance our understanding of the protective role of gut microbiota in the early life of chicks and should be instrumental in improving chick rearing in the commercial poultry industry. Video Abstract.

Pathogenicity and transmissibility of a novel respirovirus isolated from a Malayan pangolin.

The identification of SARS-CoV-2-like viruses in Malayan pangolins (Manis javanica) has focused attention on these endangered animals and the viruses they carry. We successfully isolated a novel respirovirus from the lungs of a dead Malayan pangolin. Similar to murine respirovirus, the full-length genome of this novel virus was 15 384 nucleotides comprising six genes in the order 3'-(leader)-NP-P-M-F-HN-l-(trailer)-5'. Phylogenetic analysis revealed that this virus belongs to the genus Respirovirus and is most closely related to murine respirovirus. Notably, animal infection experiments indicated that the pangolin virus is highly pathogenic and transmissible in mice, with inoculated mice having variable clinical symptoms and a fatality rate of 70.37 %. The virus was found to replicate in most tissues with the exception of muscle and heart. Contact transmission of the virus was 100 % efficient, although the mice in the contact group displayed milder symptoms, with the virus mainly being detected in the trachea and lungs. The isolation of a novel respirovirus from the Malayan pangolin provides new insight into the evolution and distribution of this important group of viruses and again demonstrates the potential infectious disease threats faced by endangered pangolins.

Photoperiod-dependent release of suppression pheromone in the male lobster cockroach Nauphoeta cinerea.

The complex agonistic repertoire between male lobster cockroaches (Nauphoeta cinerea) makes this species an excellent model for aggression studies. During the establishment of dominance hierarchies, 3-hydroxy-2-butanone (3H-2B) functions as a suppression pheromone, keeping the rivals in a submissive state. In the present study, we evaluated the release of 3H-2B by dominant individuals across four different time phases within the 24-h photoperiod, i.e., early scotophase (ES), late scotophase (LS), early photophase (EP), and late photophase (LP). For each time phase, we collected volatile pheromones during a 60-min first-encounter fight to measure the level of released 3H-2B. Subsequently, the amount of 3H-2B remaining in the sternal glands of dominant and subordinate individuals was measured and compared to socially naïve male controls. Release of 3H-2B was relatively high during ES or LP first-encounter fights, compared to LS or EP encounters. The attack duration and aggressive posture intensity in dominant males were positively correlated with the amount of 3H-2B release in all four phases. A similar statistical distribution was found between the amount of 3H-2B released by dominant males and the amount of 3H-2B in the sternal glands of naïve male sternal during LS, EP, and LP. However, during ES, the statistical distribution of 3H-2B released by the dominant was significantly greater than the distribution of 3H-2B content in socially naïve male sternal glands. The observed phase-dependence of 3H-2B release might be due to variations in 3H-2B biosynthesis or the scotophase-specific behavior of naïve males, wherein an aggressive posture is spontaneously adopted with concomitant 3H-2B release.

Interspecific competition and territory defense mechanisms of Coptotermes formosanus and Coptotermes gestroi (Isoptera: Rhinotermitidae).

Coptotermes formosanus Shiraki and C. gestroi (Wasmann) are the most widely distributed species of the genus and occur sympatrically in the subtropics. Results of two bioassays in the current study showed that C. gestroi was more aggressive than C. formosanus. In the petri-dish bioassays, C. gestroi won most of the agonistic encounters over C. formosanus. In the two-dimensional foraging arena bioassays, over 73% tunnel interceptions observed in the 18 replications were caused by progressing tunnels of C. gestroi encountering the tunnels of C. formosanus. Tunnel interception of the two species resulted in minor agonistic interactions. Both species quickly buried the connected tunnel at multiple locations. Termite cadavers resulting from agonistic behavior appeared to have induced sand deposition that resulted in tunnel blockages and deterred reopening of these blockages. Sealing individual tunnels in response to encounters with other species acts to prevent further agonism and mortality, and on a broad scale, the aggregate of such blocked tunnels may come to define the borders between adjacent colonies.

Tunneling response of termites to a pre-formed tunnel.

Subterranean termites move from place to place while foraging by tunneling through soil. During a period of foraging, they are likely to encounter a number of pre-formed tunnels created by, for example, tree roots or the breaking up of a zone of hard or compacted soil. We systematically observed the behavioral response of tunneling termites to such pre-formed, artificially constructed tunnels at widths, W, of 0.5, 1.0, 1.5, and 2.0mm, which mimicked pre-formed tunnels in the field. The two tunnels intersected at an angle, theta (=0 degrees , 10 degrees , 20 degrees , 30 degrees , 40 degrees , 50 degrees , and 60 degrees ) formed between the advance direction of a termite tunnel and the perpendicular direction of a pre-formed tunnel. For W=Wc (=0.5mm) and theta

Juvenile hormone levels are increased in winners of cockroach fights.

In lobster cockroach (Nauphoeta cinerea) adult males, concomitant expression of attack behavior and an increase in juvenile hormone (JH) III titer can be induced by contact with an isolated antenna [Chou et al., 2007. Antenna contact and agonism in the male lobster cockroach, Nauphoeta cinerea. Horm. Behav. 52, 252-260]. In the present study, socially naïve N. cinerea males that were either aggressive posture-adopting (i.e., "ready-for-fight") or not (i.e., "non-ready-for-fight") were paired to ask if status was determined by JH III levels before the encounter and if JH III levels were altered in dominants and subordinates after the encounter. The results showed that, although in the non-aggressive posture-adopting male pairs, the one with higher JH titers before the encounter was more likely to become the dominant, this was not the case in pairs formed between aggressive posture-adopting males or between non-aggressive posture-adopting and aggressive posture-adopting males. In all types of male pairs combined, JH III levels in the dominant were significantly increased after the encounter compared with before the encounter and were significantly higher than those in the subordinates, suggesting that the JH III increase in the dominants may serve to sustain aggression. JH III application before rank formation had a significant effect on establishment of dominant status in non-aggressive posture-adopting, but not aggressive posture-adopting, males. After rank formation, JH III application to subordinates had no effect on rank switch. These results indicate that the relationship between JH and aggression in this cockroach species is broadly consistent with the vertebrate challenge hypothesis, which predicts that testosterone levels increase in response to social stimuli to modulate aggression.

Pheromone, juvenile hormone, and social status in the male lobster cockroach Nauphoeta cinerea.

In this study, the major pheromone component, 3-hydroxy-2-butanone (3H-2B), released by dominants was measured during early scotophase. Both the JH III titer in the hemolymph and the 3H-2B content of the sternal glands of the dominants and subordinates were then measured during late scotophase and late photophase. These investigations were performed on encounter days 1, 2, 3, 5, 7, 9, 12, and 20. The results showed that, for non-aggressive posture (AP)-adopting socially naïve males (SNMs), both the 3H-2B release and the hemolymph JH III titer were maintained at a low level. Once a fight occurred, 3H-2B release was raised significantly in the AP-adopting dominants, but not in non-AP-adopting subordinates, and remained raised throughout the entire experimental period. At 30 min after the first encounter, the hemolymph JH III titer was significantly increased in dominants, but not in subordinates. A significantly higher hemolymph JH III titer was observed in dominants during late scotophase on days 3, 5, 12, and 20 and during late photophase on days 3, 5, and 20. After fighting, the sternal gland 3H-2B content of the dominants or subordinates was significantly lower than in SNMs. In dominants, the sternal gland 3H-2B content during late scotophase was significantly lower than that during late photophase in the first 9 domination days, while, in the subordinates, the 3H-2B content during late scotophase was either similar to, or significantly higher than, that in late photophase. In the dominants, 3H-2B release and JH III titer were positively correlated. In rank switchers, the switched social status was positively correlated with both 3H-2B release and JH III titer. Comparison of 3H-2B release and JH III titer in 1-time, 3-time, or 5-time dominants showed that, although winning significantly increased both 3H-2B release and JH III titer, there is no significant difference in 3H-2B release between 3- and 5-time winners, while the JH III titer was most significantly increased in the 3-time winners. The possible relationship between pheromone release, JH III titer, and social status is discussed.

Surface irregularity induced-tunneling behavior of the formosan subterranean termite.

Subterranean termites forage from place to place by tunneling through soil. In order to examine termite-tunneling responses to external factors, we designed a square arena that contains five introduction chambers connected with narrow paths, which was filled with sand. Triangle-shaped indentation with width W and height H was provided as surface irregularity on the sand facing the introduction chambers by using templates. After termites were introduced into the chambers, we measured elapsed time, tau, for a tunnel to reach the point at 3 mm away from the apex of the irregularity. We found that for W=0 mm (the absence of irregularity), termites (Coptotermes formosanus Shiraki) did not tunnel for approximately 7h, whereas, for W=1, 2, 3, and 4 mm, they exhibited the tunneling behavior within 20 min. The result indicated that the presence of surface irregularity is essential to induce termite tunneling. In addition, we found that W was correlated with tau, whereas H did not influence tau. This was briefly discussed in the context of individual movement behavior.

Strategic 3-hydroxy-2-butanone release in the dominant male lobster cockroach, Nauphoeta cinerea.

In the lobster cockroach Nauphoete cinerea, the dominant-subordinate hierarchy formed via the agonistic interactions is unstable, and changes in rank order are common. Our previous results showed that in the first encounter fight during initial rank formation, microgram levels of 3H-2B are released by the aggressive posture (AP)-adopting dominant male. In the present study, the pattern of daily pheromone (3H-2B) release during the domination period and on the day of rank switch, rank duration, and rank switch frequency were investigated in three-male groups and six-male groups to examine the effect of higher frequency of agonistic encounters. The results showed that, in the three-male groups (50-day observation period), daily 3H-2B release rate was not constant, but fluctuated, the average duration of dominant rank was 16.6 +/- 2.0 days, rank switch occurred in 58.8% of groups, and the frequency of rank switching (average number of rank switches/group/50 days) was 1.4 +/- 0.2. For the six-male groups (30-day observation period), the daily 3H-2B release rate also fluctuated, but the duration of dominant rank was significantly shorter at 4.2 +/- 0.6 days, rank switch occurred in 100% of groups, and the frequency of rank switching (average number of rank switches/group/30 days) was significantly higher at 6.9 +/- 0.6. The results for both sets of male groups showed that as a new rank formed (either on the first encounter day or on the day of rank switching), the dominant status was significantly associated with a higher 3H-2B release rate. In the animal kingdom, fighting usually involves communication or the exchange of signals, and the results of this study indicated that the fluctuating daily 3H-2B release rate adopted by the dominants is a kind of strategic release and the 3H-2B release rate is a signal used to determine dominance.

Antenna contact and agonism in the male lobster cockroach, Nauphoeta cinerea.

On any given day, about 35% of 80- to 85-day-old socially naïve male (SNM) lobster cockroaches (Nauphoeta cinerea) spontaneously adopted an aggressive posture (AP) without encountering another male [spontaneous AP (SAP)]. Although SAP SNMs showed significantly higher release of the pheromone 3-hydroxy-2-butanone (3H-2B) than non-SAP SNMs, there was no significant difference in hemolymph juvenile hormone (JH) III titer. When different body parts were tested for induction of the attack behavior, the antenna was found to be the most effective. After 1 min of contact with an antenna from another SAP SNM, attack behavior was induced in 100% of SAP and 76.2% of non-SAP SNMs, and the JH III titer was significantly increased in all responders. Among the non-SAP SNMs, the JH III titer before antenna contact was significantly lower in the non-responders than in the responders, and, although the JH III increase induced by 1 min antenna contact was similar between responders and non-responders, the final JH III titer of the non-responders was significantly lower. A similar attack response, JH III titer change, and 3H-2B release were seen when the individual's own antenna was used. After 5 min of contact with an antenna from another SAP SNM, attack behavior was induced in 100% of SAP and 82% of non-SAP SNMs; in the former, 3H-2B release was similar before and after antenna contact, but the JH III titer was significantly increased after antenna contact, while, in the latter, both 3H-2B release and JH III titer were significantly increased after antenna contact. Among the non-SAP SNMs, JH III titer in the non-responders was not elevated after 5 min antenna contact, and was significantly lower than that in the responders. A pentane-washed antenna did not induce attack behavior or increase the hemolymph JH III titer, and a pentane-washed antenna coated with 3H-2B also failed to induce attack behavior. These results indicate that N. cinerea male-male agonistic interactions, to which the vertebrate challenge hypothesis can be applied, are due to contact pheromone on the antenna, resulting in the concomitant expression of attack behavior and an increase in 3H-2B release and JH III titer.