An agent-based model on antimicrobial de-escalation in intensive care units: Implications on clinical trial design.

Antimicrobial de-escalation refers to reducing the spectrum of antibiotics used in treating bacterial infections. This strategy is widely recommended in many antimicrobial stewardship programs and is believed to reduce patients' exposure to broad-spectrum antibiotics and prevent resistance. However, the ecological benefits of de-escalation have not been universally observed in clinical studies. This paper conducts computer simulations to assess the ecological effects of de-escalation on the resistance prevalence of Pseudomonas aeruginosa-a frequent pathogen causing nosocomial infections. Synthetic data produced by the models are then used to estimate the sample size and study period needed to observe the predicted effects in clinical trials. Our results show that de-escalation can reduce colonization and infections caused by bacterial strains resistant to the empiric antibiotic, limit the use of broad-spectrum antibiotics, and avoid inappropriate empiric therapies. Further, we show that de-escalation could reduce the overall super-infection incidence, and this benefit becomes more evident under good compliance with hand hygiene protocols among health care workers. Finally, we find that any clinical study aiming to observe the essential effects of de-escalation should involve at least ten arms and last for four years-a size never attained in prior studies. This study explains the controversial findings of de-escalation in previous clinical studies and illustrates how mathematical models can inform outcome expectations and guide the design of clinical studies.

METTL3 Promotes Osteosarcoma Metastasis via an m6A-dependent Epigenetic Activity of CBX4.

BACKGROUND: Osteosarcoma cells are prone to metastasis, and the mechanism of N6-methyladenosine (m6A) methylation modification in this process is still unclear. Methylation modification of m6A plays an important role in the development of osteosarcoma, which is mainly due to abnormal expression of enzymes related to methylation modification of m6A, which in turn leads to changes in the methylation level of downstream target genes messenger RNA (mRNA) leading to tumor development. METHODS: We analyzed the expression levels of m6A methylation modification-related enzyme genes in GSE12865 whole-genome sequencing data. And we used shRNA (short hairpin RNA) lentiviral interference to interfere with METTL3 (Methyltransferase 3) expression in osteosarcoma cells. We studied the cytological function of METTL3 by Cell Counting Kit-8 (CCK8), flow cytometry, migration and other experiments, and the molecular mechanism of METTL3 by RIP (RNA binding protein immunoprecipitation), Western blot and other experiments. RESULTS: We found that METTL3 is abnormally highly expressed in osteosarcoma and interferes with METTL3 expression in osteosarcoma cells to inhibit metastasis, proliferation, and apoptosis of osteosarcoma cells. We subsequently found that METTL3 binds to the mRNA of CBX4 (chromobox homolog 4), a very important regulatory protein in osteosarcoma metastasis, and METTL3 regulates the mRNA and protein expression of CBX4. Further studies revealed that METTL3 inhibited metastasis of osteosarcoma cells by regulating CBX4. METTL3 has been found to be involved in osteosarcoma cells metastasis by CBX4 affecting the protein expression of matrix metalloproteinase 2 (MMP2), MMP9, E-Cadherin and N-Cadherin associated with osteosarcoma cells metastasis. CONCLUSIONS: These results suggest that the combined action of METTL3 and CBX4 plays an important role in the regulation of metastasis of osteosarcoma, and therefore, the METTL3-CBX4 axis pathway may be a new potential therapeutic target for osteosarcoma.

A stochastic dynamical model for nosocomial infections with co-circulation of sensitive and resistant bacterial strains.

Nosocomial infections (hospital-acquired) has been an important public health problem, which may make those patients with infections or involved visitors and hospital personnel at higher risk of worse clinical outcomes or infection, and then consume more healthcare resources. Taking into account the stochasticity of the death and discharge rate of patients staying in hospitals, in this paper, we propose a stochastic dynamical model describing the transmission of nosocomial pathogens among patients admitted for hospital stays. The stochastic terms of the model are incorporated to capture the randomness arising from death and discharge processes of patients. Firstly, a sufficient condition is established for the stochastic extinction of disease. It shows that introducing randomness in the model will result in lower potential of nosocomial outbreaks. Further, we establish a threshold criterion on the existence of stationary distribution and ergodicity for any positive solution of the model. Particularly, the spectral radius form of stochastic threshold value is calculated in the special case. Moreover, the numerical simulations are conducted to both validate the theoretical results and investigate the effect of prevention and control strategies on the prevalence of nosocomial infection. We show that enhancing hygiene, targeting colonized and infected patients, improving antibiotic treatment accuracy, shortening treatment periods are all crucial factors to contain nosocomial infections.

Linking mathematical models and trap data to infer the proliferation, abundance, and control of Aedes aegypti.

Aedes aegypti is one of the most dominant mosquito species in the urban areas of Miami-Dade County, Florida, and is responsible for the local arbovirus transmissions. Since August 2016, mosquito traps have been placed throughout the county to improve surveillance and guide mosquito control and arbovirus outbreak response. In this paper, we develop a deterministic mosquito population model, estimate model parameters by using local entomological and temperature data, and use the model to calibrate the mosquito trap data from 2017 to 2019. We further use the model to compare the Ae. aegypti population and evaluate the impact of rainfall intensity in different urban built environments. Our results show that rainfall affects the breeding sites and the abundance of Ae. aegypti more significantly in tourist areas than in residential places. In addition, we apply the model to quantitatively assess the effectiveness of vector control strategies in Miami-Dade County.

A novel method based on Ag-Au nanorings with tunable plasmonic properties for the sensitive detection of amantadine.

To prevent the toxic effect of amantadine (AMD) on humans, a sensitive and direct detection method is required. The conventional enzyme-linked immunosorbent assay (ELISA) usually shows a monochromatic gradient color variation with the concentration of the target; hence, it is not a sensitive method for naked-eye detection. In this work, Ag-Au nanorings with highly tunable plasmon properties were synthesized as colorimetric nanosensors. The growth of Ag on the hollow nanorings led to rich color variations. Ag-Au nanorings were integrated into ELISA for the sensitive detection of AMD with the naked eye. The proposed method showed high sensitivity for the qualitative and quantitative detection of AMD, the visible cut-off value (0.2 ng mL-1) and limit of detection (0.071 ng mL-1) were 10-fold and 4.7-fold lower, respectively, than those of conventional ELISA. This method showed a linear range of 0.08-2 ng mL-1 and 4-12 ng mL-1. The detection results of this method on 100 samples (food samples and municipal water) agreed well with those of liquid chromatography-tandem mass spectrometry. The proposed plasmonic ELISA has high sensitivity, easy operation, and naked-eye readout.

Estimating asymptomatic, undetected and total cases for the COVID-19 outbreak in Wuhan: a mathematical modeling study.

BACKGROUND: The COVID-19 outbreak in Wuhan started in December 2019 and was under control by the end of March 2020 with a total of 50,006 confirmed cases by the implementation of a series of nonpharmaceutical interventions (NPIs) including unprecedented lockdown of the city. This study analyzes the complete outbreak data from Wuhan, assesses the impact of these public health interventions, and estimates the asymptomatic, undetected and total cases for the COVID-19 outbreak in Wuhan. METHODS: By taking different stages of the outbreak into account, we developed a time-dependent compartmental model to describe the dynamics of disease transmission and case detection and reporting. Model coefficients were parameterized by using the reported cases and following key events and escalated control strategies. Then the model was used to calibrate the complete outbreak data by using the Monte Carlo Markov Chain (MCMC) method. Finally we used the model to estimate asymptomatic and undetected cases and approximate the overall antibody prevalence level. RESULTS: We found that the transmission rate between Jan 24 and Feb 1, 2020, was twice as large as that before the lockdown on Jan 23 and 67.6% (95% CI [0.584,0.759]) of detectable infections occurred during this period. Based on the reported estimates that around 20% of infections were asymptomatic and their transmission ability was about 70% of symptomatic ones, we estimated that there were about 14,448 asymptomatic and undetected cases (95% CI [12,364,23,254]), which yields an estimate of a total of 64,454 infected cases (95% CI [62,370,73,260]), and the overall antibody prevalence level in the population of Wuhan was 0.745% (95% CI [0.693%,0.814%]) by March 31, 2020. CONCLUSIONS: We conclude that the control of the COVID-19 outbreak in Wuhan was achieved via the enforcement of a combination of multiple NPIs: the lockdown on Jan 23, the stay-at-home order on Feb 2, the massive isolation of all symptomatic individuals via newly constructed special shelter hospitals on Feb 6, and the large scale screening process on Feb 18. Our results indicate that the population in Wuhan is far away from establishing herd immunity and provide insights for other affected countries and regions in designing control strategies and planing vaccination programs.

Effectiveness and feasibility of convalescent blood transfusion to reduce COVID-19 fatality ratio.

Background: As of December 2020, COVID-19 has spread all over the world with more than 81 million cases and more than 1.8 million deaths. The rapidly increasing number of patients mandates the consideration of potential treatments for patients under severe and critical conditions. Convalescent plasma (CP) treatment refers to the approach of infusing patients with plasma from recently recovered patients. CP appears to be a possible therapeutic option to manage patients suffering from severe or even lethal infectious disorders, in which 'traditional therapies' have failed to obtain any result. Methods: In the present study, we develop a mathematical model on the treatment-donation-stockpile dynamics for an optimal implementation of CP therapy to examine potential benefits and complications in the logistic realization of this therapy in a large-scale population. We parametrize the model with COVID-19 epidemics in Italy, and conduct scenario analyses to estimate outcomes of population-wide CP therapy and to examine the maximum number of CP donation processions per day. Results: Under the assumption that the efficacy of CP is 90%, we show that by the end of year 2020, initiating the population-wide CP therapy from April 2020 can save as many as 19 215 lives (ranging from 5000 to 28 000 depending on donor availability), while the demand for apheresis use is manageable in all scenarios: the maximum daily demand is 156 (ranging from 27 to 519 depending on donor availability) for the first outbreak wave and 1434 (ranging from 224 to 4817 depending on donor availability) for the second wave. Given that Italy has 61 centres with apheresis this maximum demand level corresponds to a daily average of 2.5 and 23.5 processions of CP donation being performed by each centre with respect to each outbreak wave. Conclusions: Our analyses show that population-wide CP therapy can contribute to curbing COVID-19-related deaths, and the logistic implementation is feasible for developed countries. The reduction of deaths can be very significant if the CP therapy is started earlier in the outbreak, and remains significant even if it is implemented during the outbreak peak time.

Loss of the virulence plasmid by Shigella sonnei promotes its interactions with CD207 and CD209 receptors.

Introduction. Shigella sonnei, the cause of bacillary dysentery, belongs to Gram-negative enteropathogenic bacteria. S. sonnei contains a 210 kb virulence plasmid that encodes an O-antigen gene cluster of LPSs. However, this virulence plasmid is frequently lost during replication. It is well-documented that after losing the O-antigen and becoming rough strains, the Gram-negative bacteria may express an LPS core on its surface. Previous studies have suggested that by using the LPS core, Gram-negative bacteria can interact with several C-type lectin receptors that are expressed on antigen-presenting cells (APCs).Hypothesis/Gap Statement. S. sonnei by losing the virulence plasmid may hijack APCs via the interactions of LPS-CD209/CD207.Aim. This study aimed to investigate if the S. sonnei rough strain, by losing the virulence plasmid, interacted with APCs that express C-type lectins of human CD207, human CD209a and mouse CD209b.Methodology. SDS-PAGE silver staining was used to examine the O-antigen expression of S. sonnei WT and its rough strain. Invasion assays and inhibition assays were used to examine the ability of S. sonnei WT and its rough strain to invade APCs and investigate whether CD209 and CD207 are receptors for phagocytosis of rough S. sonnei. Animal assays were used to observe the dissemination of S. sonnei.Results. S. sonnei did not express O-antigens after losing the virulence plasmid. The S. sonnei rough strain invades with APCs, including human dendritic cells (DCs) and mouse macrophages. CD209 and CD207 are receptors for phagocytosis of rough S. sonnei. Expression of the O-antigen reduces the ability of the S. sonnei rough strain to be disseminated to mesenteric lymph nodes and spleens.Conclusion. This work demonstrated that S. sonnei rough strains - by losing the virulence plasmid - invaded APCs through interactions with CD209 and CD207 receptors.

Preparation of Antioxidant Peptide by Microwave- Assisted Hydrolysis of Collagen and Its Protective Effect Against H2O2-Induced Damage of RAW264.7 Cells.

Antioxidant peptides have elicited interest for the versatility of their use in the food and pharmaceutical industry. In the current study, antioxidant peptides were prepared by microwave-assisted alkaline protease hydrolysis of collagen from sea cucumber (Acaudina molpadioides). The results showed that microwave irradiation significantly improved the degree of hydrolysis of collagen and the hydroxyl radical (OH⋅) scavenging activity of hydrolysate. The content and OH⋅ scavenging activity of collagen peptides with molecular weight ≤ 1 kDa (CPS) in the hydrolysate obtained at 250 W increased significantly compared with the non-microwave-assisted control. CPS could scavenge OH⋅ and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical in a dose-dependent manner. The scavenging activity of OH⋅ and DPPH radical was 93.1% and 41.2%, respectively, at CPS concentration of 1 mg/mL. CPS could significantly promote RAW264.7 cell proliferation and reduce the Reactive Oxygen Species (ROS) level of H2O2-induced damage in RAW264.7 cells in a dose-dependent manner. Furthermore, all CPS-treated groups exhibited an increase in superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) and a decrease in malondialdehyde (MDA) level compared with the control. These results showed that CPS could effectively protect RAW264.7 cells from H2O2-induced damage, implying the potential utilization of CPS as a natural antioxidant for food and pharmaceutical applications.

Modelling and Analyzing Virus Mutation Dynamics of Chikungunya Outbreaks.

Chikungunya fever, caused by chikungunya virus (CHIKV) and transmitted to humans by infected Aedes mosquitoes, has posed a global threat in several countries in 2015. Recent outbreaks in La Réunion, Italy and China are related with a new variant of CHIKV with shorter extrinsic incubation period in contaminated mosquitoes, but the role of this new variant on the spread of chikungunya fever is unclear. We develop a mathematical model that incorporates the virus mutation dynamics in the transmission of CHIKV among mosquitoes and humans. Our numerical simulations show that a substantial virus mutation rate combined with high virus transmission probabilities from mosquito to human, could result in sustainable chikungunya fever outbreaks. Further, we apply Markov Chain Monte Carlo sampling method to fit our model to the 2007 chikungunya fever outbreak data in North-Eastern Italy where the mutant strain was detected. We conclude that the basic reproduction number might be underestimated without considering the mutation dynamics, and our estimation shows that the basic reproduction number of the 2007 Italy outbreak was [Formula: see text] = 2.035[95%Cl: 1.9424 - 2.1366]. Sensitivity analysis shows that the transmission rate of the mutant strain from mosquitoes to human is more influential on [Formula: see text] than the shortened extrinsic incubation period. We conclude that the virus mutation dynamics could play an important role in the transmission of CHIKV, and there is a crucial need to better understand the mutation mechanism.

1H NMR combined with PLS for the rapid determination of squalene and sterols in vegetable oils.

Proton nuclear magnetic resonance (1H NMR) combined with partial least squares (PLS) was developed for the rapid determination of squalene and sterols (brassicasterol, campesterol, stigmasterol and ß-sitosterol) in 119 vegetable oils from 7 different species. The 1H NMR spectra of these oil samples were correlated to the reference value determined by gas chromatography-mass spectrometry (GC-MS) method by PLS regression, using outlier removal, selection of input X-variables and data pretreatments. Auto-scaling (UV) was chosen as the best pre-processing for the PLS models of stigmasterol, ß-sitosterol, and squalene. Pareto variance (Par) was more suitable for the PLS model of brassicasterol. The model for squalene was further improved by a reduced number of variables with variable importance for the projection (VIP) scores technique. The study demonstrated the potential application of NMR coupled with PLS as a rapid and nondestructive technique for the routine analysis of squalene and sterols in vegetable oils.

Fabrication of Carboxymethylcellulose/Metal-Organic Framework Beads for Removal of Pb(II) from Aqueous Solution.

The ability to remove toxic heavy metals, such as Pb(II), from the environment is an important objective from both human-health and ecological perspectives. Herein, we describe the fabrication of a novel carboxymethylcellulose-coated metal organic material (MOF-5⁻CMC) adsorbent that removed lead ions from aqueous solutions. The adsorption material was characterized by Fourier-transform infrared spectroscopy, X-ray diffractometry, scanning electron microscopy, and X-ray photoelectron spectroscopy. We studied the functions of the contact time, pH, the original concentration of the Pb(II) solution, and adsorption temperature on adsorption capacity. MOF-5⁻CMC beads exhibit good adsorption performance; the maximum adsorption capacity obtained from the Langmuir isotherm-model is 322.58 mg/g, and the adsorption equilibrium was reached in 120 min at a concentration of 300 mg/L. The adsorption kinetics is well described by pseudo-second-order kinetics, and the adsorption equilibrium data are well fitted to the Langmuir isotherm model (R² = 0.988). Thermodynamics experiments indicate that the adsorption process is both spontaneous and endothermic. In addition, the adsorbent is reusable. We conclude that MOF-5⁻CMC is a good adsorbent that can be used to remove Pb(II) from aqueous solutions.

Optimal control of environmental cleaning and antibiotic prescription in an epidemiological model of methicillin-resistant Staphylococcus aureus infections in hospitals.

We consider a deterministic model of Methicillin-resistant Staphylococcus aureus infections in hospitals with seasonal oscillations of the antibiotic prescription rate. The model compartments consist of uncolonized patients with or without antibiotic exposure, colonized patients with or without antibiotic exposure, uncontaminated or contaminated healthcare workers, and free-living bacteria in the environment. We apply optimal control theory to this seven-compartment periodic system of ordinary differential equations to reduce the number of colonized patients and density of bacteria in the environment while minimizing the cost associated with environmental cleaning and antibiotic use in a particular time period. Characterizations of optimal control strategies are formulated and the ways hospitals should adjust these strategies for different scenarios are discussed. Numerical simulations strongly suggest that environmental cleaning is essential in the control of MRSA infections and antibiotic usage is suggested to be maintained at the least possible level. Screening, isolating, and shortening the extremely lengthened stays of colonized patients with antibiotic use history are all effective intervention strategies.

Preparation and Evaluation of Peptides with Potential Antioxidant Activity by Microwave Assisted Enzymatic Hydrolysis of Collagen from Sea Cucumber Acaudina Molpadioides Obtained from Zhejiang Province in China.

The present study was focused on the preparation and characterization of the antioxidant peptides by microwave-assisted enzymatic hydrolysis of collagen from sea cucumber Acaudina molpadioides (ASC-Am) obtained from Zhejiang Province in China. The results exhibited the effects of microwave irradiation on hydrolysis of ASC-Am with different protease. Neutrase was selected from the four common proteases (papain, pepsin, trypsin, and neutrase) based on the highest content and DPPH scavenging activity of hydrolysate Fa (Molecular weight < 1 kDa). The content and 2,2-diphenyl-1-picrylhydrazyl (DPPH) scavenging activity of Fa obtained by hydrolysis of neutrase increased by 100% and 109% respectively at a microwave power of 300 W compared with no microwave irradiation. Five subfractions were obtained after performing the gel filtration chromatography, and the Fa.2 exhibited the highest DPPH scavenging activity. The amino acid analysis showed that the contents of Glutamic acid, Alanine, Tyrosine, and Phenylalanine in fraction Fa.2 increased significantly, but an obvious decrease in the content of Glycine was observed compared to Fa. Four peptides (Fa.2-A, Fa.2-B, Fa.2-C, and Fa.2-D) were purified from Fa.2 by high performance liquid chromatography, and Fa.2-C showed the highest DPPH scavenging activity. The sequence of Fa.2-C was identified as Phenylalanine-Leucine- Alanine-Proline with a half elimination ratio (EC50) of 0.385 mg/mL. The antioxidant activity of Fa.2-C was probably attributed to the small molecular sizes and the presence of hydrophobic amino acid residues in its sequence. This report provided a promising method for the preparation of antioxidant peptides from collagen for food and medicinal purposes.

Modeling Antibiotic Use Strategies in Intensive Care Units: Comparing De-escalation and Continuation.

Antimicrobial de-escalation refers to the treatment mechanism of switching from empiric antibiotics with good coverage to alternatives based on laboratory susceptibility test results, with the aim of avoiding unnecessary use of broad-spectrum antibiotics. In a previous study, we have developed multi-strain and multi-drug models in an intensive care unit setting, to evaluate the benefits and trade-offs of de-escalation in comparison with the conventional strategy called antimicrobial continuation. Our simulation results indicated that for a large portion of credible parameter combinations, de-escalation reduces the use of the empiric antibiotic but increases the probabilities of colonization and infections. In this paper, we first simplify the previous models to compare the long-term dynamical behaviors between de-escalation and continuation systems under a two-strain scenario. The analytical results coincide with our previous findings in the complex models, indicating the benefits and unintended consequences of de-escalation strategy result from the nature of this treatment mechanism, not from the complexity of the high-dimensional systems. By extending the models to three-strain scenarios, we find that de-escalation is superior than continuation in preventing outbreaks of invading strains that are resistant to empiric antibiotics. Thus decisions on antibiotic use strategies should be made specifically according to ICU conditions and intervention objectives.

Modeling the seasonality of Methicillin-resistant Staphylococcus aureus infections in hospitals with environmental contamination.

A deterministic mathematical model with periodic antibiotic prescribing rate is constructed to study the seasonality of Methicillin-resistant Staphylococcus aureus (MRSA) infections taking antibiotic exposure and environmental contamination into consideration. The basic reproduction number R0 for the periodic model is calculated under the assumption that there are only uncolonized patients with antibiotic exposure at admission. Sensitivity analysis of R0 with respect to some essential parameters is performed. It is shown that the infection would go to extinction if the basic reproduction number is less than unity and would persist if it is greater than unity. Numerical simulations indicate that environmental cleaning is the most important intervention to control the infection, which emphasizes the effect of environmental contamination in MRSA infections. It is also important to highlight the importance of effective antimicrobial stewardship programmes, increase active screening at admission and subsequent isolation of positive cases, and treat patients quickly and efficiently.

A conceptual model for optimizing vaccine coverage to reduce vector-borne infections in the presence of antibody-dependent enhancement.

BACKGROUND: Many vector-borne diseases co-circulate, as the viruses from the same family are also transmitted by the same vector species. For example, Zika and dengue viruses belong to the same Flavivirus family and are primarily transmitted by a common mosquito species Aedes aegypti. Zika outbreaks have also commonly occurred in dengue-endemic areas, and co-circulation and co-infection of both viruses have been reported. As recent immunological cross-reactivity studies have confirmed that convalescent plasma following dengue infection can enhance Zika infection, and as global efforts of developing dengue and Zika vaccines are intensified, it is important to examine whether and how vaccination against one disease in a large population may affect infection dynamics of another disease due to antibody-dependent enhancement. METHODS: Through a conceptual co-infection dynamics model parametrized by reported dengue and Zika epidemic and immunological cross-reactivity characteristics, we evaluate impact of a hypothetical dengue vaccination program on Zika infection dynamics in a single season when only one particular dengue serotype is involved. RESULTS: We show that an appropriately designed and optimized dengue vaccination program can not only help control the dengue spread but also, counter-intuitively, reduce Zika infections. We identify optimal dengue vaccination coverages for controlling dengue and simultaneously reducing Zika infections, as well as the critical coverages exceeding which dengue vaccination will increase Zika infections. CONCLUSION: This study based on a conceptual model shows the promise of an integrative vector-borne disease control strategy involving optimal vaccination programs, in regions where different viruses or different serotypes of the same virus co-circulate, and convalescent plasma following infection from one virus (serotype) can enhance infection against another virus (serotype). The conceptual model provides a first step towards well-designed regional and global vector-borne disease immunization programs.

17ß-Estradiol inhibits intervertebral disc degeneration by down-regulating MMP-3 and MMP-13 and up-regulating type II collagen in a rat model.

OBJECTIVES: This study was aimed to further explore whether estradiol (E2) had protective effects on intervertebral disc degeneration (IVDD) in a rat model. MATERIAL/METHODS: Forty, three-month-old female Sprague Dawley (SD) rats were randomly divided into four groups: Sham, Ovariectomy (OVX), E2 and ICI182780 (ICI). Sham group only underwent the resection of a bit fat; OVX group underwent bilateral ovariectomy; E2 group was treated with E2 based on OVX; ICI group was treated with E2 and pretreated ICI182780 (inhibitor of the estrogen receptor) based on OVX. Radiography, hematoxylin and eosin (HE) staining, immunohistochemistry (IHC), western blot and quantitative real-time PCR (qRT-PCR) were applied to detect the apoptosis characteristics of intervertebral disc cells. RESULTS: Radiographs showed marked intervertebral disc narrowing and HE staining showed typical apoptosis characteristics of intervertebral disc cells in OVX, which were reversed by E2. Furthermore, the results of IHC, Western blot and qRT-PCR revealed that OVX-induced IVDD was protected by E2 through decreasing the expression of caspase-3 and intracellular matrix metalloproteinases (MMPs), including MMP-3 and MMP-13, while increasing the expression of collagen Type II. All of the detected effects of E2 were abolished after treatment with ICI182780. CONCLUSION: 17ß-E2 inhibits IVDD by down-regulating MMP-3 and MMP-13 and up-regulating collagen Type II in a rat model.

Two Cases of Multi-antibiotic Resistant Cronobacter spp. Infections of Infants in China.

Infections by Cronobacter spp. are hazardous to infants since they can lead to neonatal meningitis, bacteremia, and necrotizing enterocolitis. Cronobacter spp. are frequently resistant to ß-lactam derivatives, macrolides, and aminoglycosides. In addition, multi-resistant strains have also been detected. In China, the isolation rate of Cronobacter spp. from commercial powdered infant formula (PIF) or follow-up formula (FUF) is relatively high. Nevertheless, clinical cases of Cronobacter infection have been ignored to date. Here we describe two cases of Cronobacter infection detected at the Wuhan Women and Children Medical Care Center Hospital (Wuhan City, China). We provide the genomic analysis of the isolates and the antibiotic-resistance profiles of the two strains. The Cronobacter strains identified in this study were not susceptible to third-generation cephalosporins, aminoglycoside, and/or trimethoprim-sulfamethoxazole. Whole genome sequencing revealed various genes known to encode antibiotic resistance. Future studies are needed to determine whether the genes predicted in this study are functional. As with Enterobacter spp., the antibiotic resistance of Cronobacter is a serious issue that requires more attention.

Benefits and unintended consequences of antimicrobial de-escalation: Implications for stewardship programs.

Sequential antimicrobial de-escalation aims to minimize resistance to high-value broad-spectrum empiric antimicrobials by switching to alternative drugs when testing confirms susceptibility. Though widely practiced, the effects de-escalation are not well understood. Definitions of interventions and outcomes differ among studies. We use mathematical models of the transmission and evolution of Pseudomonas aeruginosa in an intensive care unit to assess the effect of de-escalation on a broad range of outcomes, and clarify expectations. In these models, de-escalation reduces the use of high-value drugs and preserves the effectiveness of empiric therapy, while also selecting for multidrug-resistant strains and leaving patients vulnerable to colonization and superinfection. The net effect of de-escalation in our models is to increase infection prevalence while also increasing the probability of effective treatment. Changes in mortality are small, and can be either positive or negative. The clinical significance of small changes in outcomes such as infection prevalence and death may exceed more easily detectable changes in drug use and resistance. Integrating harms and benefits into ranked outcomes for each patient may provide a way forward in the analysis of these tradeoffs. Our models provide a conceptual framework for the collection and interpretation of evidence needed to inform antimicrobial stewardship.