[Comparison of early outcome between one-stage hybrid technique and frozen elephant thunk technique in the treatment of Stanford A aortic dissection involving the arch].

Objective: To analyze the early outcome of one-stage hybrid technique in the treatment of Stanford type-A aortic dissection involving the arch and compare its therapeutic efficacy with the classical frozen elephant trunk technique (FET). Methods: A total of 106 patients with Stanford type-A aortic dissection involving the arch in Department of Cardiac and Vascular Surgery, 1st Affiliated Hospital of Soochow University from October 2015 to October 2019 was collected. All patients in this group were treated with one-stage hybrid technique (modified arch debranching technique) without deep hypothermia circulation. Meanwhile, 30 patients with Stanford type A dissection involving the arch who underwent FET from January 2014 to September 2015 were collected. The therapeutic effects of the two surgical methods were analyzed and compared. Results: The age [M (Q1, Q3)] of 106 patients in hybrid group was 49.0 (40.0, 55.0) years, including 89 males and 17 females. The age [M(Q1, Q3)] of 30 patients in FET group was 49.5 (41.5, 65.3) years, including 24 males and 6 females. The time [M(Q1, Q3)] of using ventilator in hybrid group was 56.0 (38.0, 72.0) h, which was shorter than 127.0 (92.0, 145.0) h in FET group (P<0.001). The incidence of cerebral infarction in hybrid group was 2.8% (3 cases), which was lower than 13.3% (4 cases) in FET group (P=0.042); the incidence of postoperative renal insufficiency in hybrid group was 7.5% (8 cases), which was lower than 23.3% (7 cases) in FET group (P=0.023); the ICU time [M (Q1, Q3)] in hybrid group was 8.0 (6.0, 10.0) d, which was shorter than 14.0 (8.3, 24.0) d in FET group (P<0.001). Conclusion: Compared with FET, one-stage hybrid technology is safer and more effective in the treatment of Stanford type A aortic dissection involving the arch. Its short-term therapeutic efficacy appears good.

Study of structural and magnetic properties and heat induction of gadolinium-substituted manganese zinc ferrite nanoparticles for in vitro magnetic fluid hyperthermia.

This article outlines the synthesis of gadolinium (Gd)-doped manganese zinc ferrite magnetic nanoparticles (MNPs) as potential magnetic carriers for magnetic fluid hyperthermia (MFH). MNPs with high specific loss power (SLP; 146 W/g) have been developed and used for an in vitro hyperthermia study. The treatment of MFH is fruitful if there is an adequate number of MNPs in tumor cells with the highest SLP to rapidly generate heat while minimizing thermal injury to surrounding healthy tissue. X-ray diffraction patterns of the studied particles confirm the formation of a cubic spinel structure. Field emission scanning electron micrographs showed homogeneous distributions of particles with some agglomerates with a granular appearance. Transmission electron microscopy analysis showed the presence of agglomerated spherical particles at the surface. The substitution of Gd resulted in superparamagnetism at room temperature as confirmed by vibrating sample magnetometer analysis. The estimated saturation magnetization reduced from 48.6 to 28.2 emu/g with an increase in Gd concentration. However, the coercivity increased from 1093 Oe to 1597 Oe. Field cooled and zero field cooled measurements showed Curie temperatures from 315 to 326 K, as required for MFH applications. Cell viability measurements indicated that the MNPs are nontoxic to A549 cells for the studied concentrations of particle fraction and a contact time of up to 24 h. The interaction of the MNPs with A549 cells was highlighted from an image captured by an inverted microscope. In order to treat cancer in vivo, an in vitro hyperthermia study has initially been carried out with A549 cells.

[Analysis of factors associated with failure of sequential mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease complicated with respiratory failure].

Objective: By retrospectively analyzing the clinical data of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with respiratory failure, to find the associated factors for failure of invasive-noninvasive sequential ventilation therapy. Methods: We conducted a cohort study of 64 patients with AECOPD complicated with respiratory failure, who were treated by invasive-noninvasive sequential ventilation. We took re-intubation, death or spontaneous discharge within 7 days following extubation as the endpoints. By comparing the APACHE Ⅱ score at admission into RICU, the ABCD grouping for COPD, the ratio of the diameter of the pulmonary artery to the diameter of the ascending aorta in chest CT(PA: A ratio), the levels of NT-proBNP, PaCO(2), PaO(2), the total number of leukocytes and the level of procalcitonin, we analyzed the differences between the success group(43 cases) and the failure group(21 cases). Results: The APACHE Ⅱ score at admission to RICU, the PA: A ratio, the level of NT-proBNP, the total leukocytes and the level of procalcitonin at admission to RICU showed significant differences in the univariate analysis(P<0.05). The average APACHE Ⅱ score was 23±4 in the success group and 27±6 in the failure group. The average PA: A ratio was 0.88±0.09 in the success group and 1.03±0.10 in the failure group. In the multivariate regression analysis, there were significant differences only in the APACHE Ⅱ score(P=0.02)and the PA: A ratio(P=0.012). The area under the ROC curve of the PA: A ratio for all patients was 0.894 and the cut-off value of the PA: A ratio was 0.98. Conclusion: The APACHE Ⅱ score and the PA: A ratio in CT are independent risk factors for failure of sequential ventilation in AECOPD patients complicated with respiratory failure. In particular, patients with a PA: A ratio greater than 0.98 have a higher risk of treatment failure.

[Expert consensus on the diagnosis and treatment of cryptococcal meningitis].

Cryptococcal meningitis is a common and refractory central nervous system infection, with high rates of mortality and disability. The experts of the Society of Infectious Diseases of Chinese Medical Association have reached this consensus after a thorough discussion. Based on the current situation of cryptococcal meningitis in China, the management of cryptococcal meningitis includes 6 aspects: introduction, microorganism identification, clinical manifestations and diagnosis, principles of antifungal therapy, treatment of refractory and recurrent meningitis, treatment of intracranial hypertension. There is not a separate consensus on human immunodeficiency virus (HIV) infection in patients with cryptococcal meningitis. This article focuses on different antifungal regimens and reducing intracranial pressure by reference to Infectious Disease Society of America (IDSA) guidelines. The importance of early diagnosis, combined long-term antifungal therapy, control of intracranial hypertension are emphasized.

[Mechanisms of fosfomycin resistance of extended-spectrum ß-lactamases-producing Escherichia coli and Klebsiella pneumoniae].

Objective: To study the in vitro activity of fosfomycin to extended-spectrum ß-lactamases (ESBLs)-producing Escherichia coli and Klebsiella pneumoniae and to explore the mechanisms of fosfomycin resistance. Methods: A total of 1 052 ESBLs-producing E. coli(ESBL-EC) and K. pneumoniae(ESBL-KP) isolates were collected from bloodstream infections of 28 hospitals of 22 provinces and municipalities, which were stored by our laboratory.Minimum inhibitory concentrations (MICs) of fosfomycin against these clinical isolates were determined by agar dilution methods according to the Clinical and Laboratory Standards Institute (CLSI)(2015). The genes related to fosfomycin resistance were confirmed by Polymerase Chain Reaction (PCR) and sequencing. Results: The susceptibility rates of ESBL-EC and ESBL-KP isolates to fosfomycin were 91.3% (818/896) and 91.7% (143/156), respectively. A total of 91 fosfomycin-non-susceptible isolates were detected, of which 73 (80.2%) isolates carried fosA3 genes.Amongst 18 fosA3-negative isolates, 16 isolates were detected to have chromosomal mutations or insertion inactivation, while the rest two isolates had not been detected any resistant mechanisms. Conclusions: Fosfomycin shows great in vitro antimicrobial activity to ESBL-EC and ESBL-KP. The primary mechanism of fosfomycin-non-susceptible isolates is fosA3 gene.Chromosomal mutations may also involve in the fosfomycin resistance.

[The activity of moxalactam against Enterobacteriaceae and anaerobia in vitro].

OBJECTIVE: To observe the antibacterial activity of moxalactam against Enterobacteriaceae bacteria and anaerobic bacteria in vitro, and to compare with other antibacterial drugs, for providing experimental basis for the clinical application of moxalactam. METHODS: Minimum inhibitory concentrations (MICs) of moxalactam and other antibacterial agents against 491 Enterobacteriaceae spp. and anaerobic spp.collecting from clinical settings were determined by agar dilution methods and E-test strips according to the Clinical and Laboratory Standards Institute (CLSI)(2014). RESULTS: Moxalactam showed great antibacterial activity to Enterobacteriaceae spp., including ESBLs-producing Escherichia coli, Klebsiella pneumoniae, and Proteus spp., with the MIC(50), MIC(90), and susceptibility rates of 0.25-4 mg/L, 0.5-8 mg/L, and >90%, respectively. The susceptibility rates of Enterobacteriaceae with ESBLs-producing or non-ESBLs-producing to imipenem and meropenem were both higher than 90%. The susceptibility rates of ESBLs-producing Escherichia coli, Klebsiella pneumoniae, and Proteus spp.to piperacillin/tazobactam and cefoperazone/sulbactam were 90%, 68%, 53% and 76%, 66%, 76.6%, respectively, while the susceptibility rates of non-ESBLs-producing Escherichia coli, Klebsiella pneumoniae, and Proteus spp.were all more than 95%. The susceptibility rates of Enterobacter spp. and other Enterobacter to piperacillin/tazobactam were 80%, 80%and that to cefoperazone/sulbactam were 80%, 76.7%, respectively.The MICs range of moxalactam on anaerobic spp.was from ≤0.064 to >256 mg/L, while MIC(50) was 2 mg/L and MIC(90) was 64 mg/L. CONCLUSIONS: Moxalactam showed well activity against ESBLs-producing and non-ESBLs-producing Enterobacteriaceae and anaerobia.

Resistance trends among clinical isolates in China reported from CHINET surveillance of bacterial resistance, 2005-2014.

With the aim of gathering temporal trends on bacterial epidemiology and resistance from multiple laboratories in China, the CHINET surveillance system was organized in 2005. Antimicrobial susceptibility testing was carried out according to a unified protocol using the Kirby-Bauer method or automated systems. Results were analyzed according to Clinical and Laboratory Standards Institute (CLSI) 2014 definitions. Between 2005 and 2014, the number of bacterial isolates ranged between 22,774 and 84,572 annually. Rates of extended-spectrum ß-lactamase production among Escherichia coli isolates were stable, between 51.7 and 55.8%. Resistance of E. coli and Klebsiella pneumoniae to amikacin, ciprofloxacin, piperacillin/tazobactam and cefoperazone/sulbactam decreased with time. Carbapenem resistance among K. pneumoniae isolates increased from 2.4 to 13.4%. Resistance of Pseudomonas aeruginosa strains against all of antimicrobial agents tested including imipenem and meropenem decreased with time. On the contrary, resistance of Acinetobacter baumannii strains to carbapenems increased from 31 to 66.7%. A marked decrease of methicillin resistance from 69% in 2005 to 44.6% in 2014 was observed for Staphylococcus aureus. Carbapenem resistance rates in K. pneumoniae and A. baumannii in China are high. Our results indicate the importance of bacterial surveillance studies.

Risk factors associated with aortic remodeling in patients with Stanford type B aortic dissection after thoracic endovascular aortic repair.

To determine the risk factors associated with adverse aortic remodeling after thoracic endovascular aortic repair (TEVAR) in patients with Stanford type B aortic dissection, we performed a retrospective analysis of 54 patients between January 2009 and June 2012 at the First Affiliated Hospital of Soochow University. All patients underwent TEVAR of the descending thoracic aorta. Multiple-logistic regression analyses were performed to identify risk factors associated with aortic remodeling. True-lumen and false-lumen volumes were increased (P < 0.001) and decreased (P < 0.001) after surgery, respectively. Therefore, the remodeling index increased after surgery (1.04 ± 0.6 to 2.06 ± 1.12, P < 0.001). Remodeling index and true-lumen volume were higher in the favorable aortic remodeling group compared to the adverse aortic remodeling group (P < 0.001), while the false-lumen volume was lower in the favorable aortic remodeling group (P < 0.001). Multivariate analyses revealed a branch originating from the false lumen (OR = 39.9, P < 0.01) and multiple tears (OR = 27.4, P < 0.01) to be independent risk factors for adverse aortic remodeling. Therefore, a branch originating from the false lumen and multiple tears were determined to be independent risk factors for adverse aortic remodeling after TEVAR in patients with Stanford type B aortic dissection.

Gene expression profiles of primary retinal pigment epithelial cells from apolipoprotein E knockout and human apolipoprotein E2 transgenic mice.

Age-related macular degeneration (AMD) causes visual impairment in the elderly. In non-neovascular AMD, studies involving human subjects have suggested potential involvement of aberrant lipid metabolism. However, there have been no reports on gene expression patterns in animal models of non-neovascular AMD with abnormal lipid metabolism such as apolipoprotein E knockout and human apolipoprotein E2 transgenic mice. Transcriptome analysis was performed using retinal pigment epithelium cells of apoE knockout and apolipoprotein E2 mice using microarray analysis. C57BL/6, Rxrb, Pparbp, Vldlr, and Edf1, which are primarily related to lipid metabolism, were upregulated, while Tgfbr1 and Pdgfb, which are related to pathologic angiogenesis in AMD, were downregulated in both types of mice. Apolipoprotein E knockout and apolipoprotein E2 mice showed characteristic gene expression patterns in the transcriptome analysis of primary retinal pigment epithelium cells. These results suggest that specific genes associated with lipid metabolism and angiogenesis are involved in the pathogenesis and progression of AMD.

Metformin inhibits hepatitis B virus protein production and replication in human hepatoma cells.

Hepatitis B virus surface antigen (HBsAg) plays an important role in maintaining the tolerance and may interfere with host innate and adaptive immune responses; therefore, novel therapeutic strategies to reduce HBsAg loads in patients infected with hepatitis B virus (HBV) are emerging as an attractive but challenging issue. Metformin could regulate hepatic metabolism while the latter interacts with HBV infection. We hypothesized that metformin could affect HBsAg expression and HBV replication and may work synergistically when combined with current antivirals. In our study, a notably inhibitory effect on HBsAg production, as well as a moderate inhibition in HBV replication and HBeAg expression was observed following metformin treatment. The 50% effective concentration (EC50) for extracellular HBsAg and intracellular HBsAg in HBV-producing HepG2.2.15 cells was 2.85 mm and 2.75 mm, respectively, with a similarly selective index of about 18. When administered in combination, metformin enhanced the inhibitory effects of interferon-α2b on HBsAg expression and HBV replication and provided a complimentary role in HBsAg expression for lamivudine (LMV). This novel action of metformin derives partially from its inhibition on multiple HBV cis-acting elements. By the virtues of preferably hepatocyte distribution and safety profile, collectively, our results suggest that metformin would be potentially clinically helpful as an HBsAg production inhibitor.

Delayed onset atypical vitreoretinal traction band formation after an intravitreal injection of bevacizumab in stage 3 retinopathy of prematurity.

PURPOSE: To report a series of patients who presented with an atypical retinal traction band, which was developed after an intravitreal injection of bevacizumab for stage 3 retinopathy of prematurity (ROP). METHODS: We retrospectively reviewed the medical record of three patients (five eyes) who had been referred to a tertiary care centre for the management of fibrous retinal traction band, which occurred after a bevacizumab injection for stage 3 ROP with plus disease. Clinical features and courses of these eyes were described based on the medical record and RetCam fundus photography. RESULTS: All three patients had taken an intravitreal injection of bevacizumab with or without concomitant laser photocoagulation as an initial treatment option for the active stage 3 ROP. With close follow-ups, regression of extraretinal fibrovascular proliferation and plus disease was noted invariably. After the regression of ROP, atypical fibrous traction membrane had arisen along the major vascular arcades with 2.5 to 4 months of latency, which progressed into tractional retinal detachment (TRD) in three out of five eyes. CONCLUSION: In active stage 3 ROP, fibrous tractional membrane and subsequent TRD along the major vascular arcades were developed unpredictably after the regression of neovascular activity following bevacizumab injection as an initial treatment. Therefore, ROP patients who received bevacizumab treatment without previous retinal photocoagulation should be closely followed for more than 4 months after the treatments even if the disease seems to have regressed.

Long-term clinical course and visual outcome associated with Peters' anomaly.

PURPOSE: To investigate the long-term clinical course and visual outcomes of Peters' anomaly cases treated with various treatment modalities. PATIENTS AND METHODS: All patients with Peters' anomaly treated at Seoul National University Children's Hospital from 1985 to 2005 were reviewed retrospectively. Patients who were followed for more than 5 years after the first visit were enrolled for analysis of the visual outcome. Final visual outcomes were presented with respect to disease severity and treatment modalities. Disease severity was determined according to the corneal status and accompanied eye anomalies in mild or severe form. Treatment plans were classified into the following groups: (1) a medical treatment group; (2) a surgical treatment group; and (3) a no-treatment group. RESULTS: A total of 106 eyes in 76 patients were diagnosed as Peters' anomaly, and 90 eyes in 65 patients were analysed regarding the visual outcome. Overall, 60 eyes (67%) had severe disease, and 30 eyes (33%) had mild disease. Twenty-six eyes (29%) received medical treatment, 44 eyes (49%) received surgical treatment, and 20 eyes (22%) received no treatment. The mean final visual acuity was 1.415 logMAR, 2.344 logMAR, and 2.282 logMAR, respectively. The visual outcomes of the eyes with mild disease in each group were significantly better than the eyes with severe disease. CONCLUSIONS: The long-term visual outcomes of Peters' anomaly differed according to the disease severity in each treatment group. Therefore, before making treatment plans for Peters' anomaly, it is important to investigate the corneal status and accompanying eye disease to determine disease severity.

Meat quality and carcass traits in relation to HGD-BstXI and HGD-HaeIII PCR-RFLP polymorphism in Chinese red cattle.

We investigated the effect of homogentisate 1, 2 dioxygenase (HGD) gene on meat quality and carcass traits in 287 Chinese red cattle. The PCR-SSCP method was used to identify polymorphism of the HGD gene in the exon 1 and intron 1. Two polymorphisms were detected in intron 1 and two restriction sites for endonuclease HGD-BstXI and HGD-HaeIII have also been found. The HGD-BstXI genotypes showed significant effects on cooking loss, drip loss, net meat weight, carcass weight, and eye muscle area (P<0.05). The HGD-HaeIII genotypes significant affected cooking loss, muscle fibre diameter, shear force, drip loss, and carcass yield ratio (P<0.05). Moreover, we found significant effects of diplotypes on cooking loss, muscle fibre diameter, shear force, drip loss, net meat weight, carcass weight, and eye muscle area (P<0.05).

Antimicrobial resistance and molecular characterization of Staphylococcus haemolyticus in a Chinese hospital.

The aim of this study was to perform the molecular characterization of methicillin-resistant Staphylococcus haemolyticus (MRSH) from clinical specimens of patients in a Chinese hospital. One hundred and thirty-three strains of S. haemolyticus collected from April 2002 to April 2003 were analyzed. Antimicrobial susceptibility to 15 antimicrobial agents was determined by the broth microdilution method. The resistant rates to penicillin G and oxacillin were higher than 90%. There were no isolates resistant to linezolid or vancomycin, and only 6.0% of the strains were resistant to teicoplanin. The positivity rate for mecA genes was 90.2% by polymerase chain reaction (PCR). Ninety MRSH (isolated from inpatients and mecA-gene-positive) were genotyped by pulsed-field gel electrophoresis (PFGE) after SmaI digestion. Twenty-five different PFGE patterns (A approximately Y) were found and a major clone (type A; n = 36) with five subtypes was identified. Clone A was detected during a 1-year period. Identical PFGE types were found in different wards and patients. The results of this study suggest the clonal spread of MRSH within our hospital. This emphasizes the need for control and prevention measures.

Serratia marcescens endophthalmitis associated with intravitreal injections of bevacizumab.

PURPOSE: To report two cases of Serratia marcescens endophthalmitis related to presumed aliquot drug contamination, and to determine the incidence of acute endophthalmitis after intravitreal injection of bevacizumab. METHODS: A retrospective chart review of 2020 consecutive intravitreal bevacizumab injection (IVBI) cases at the three affiliated hospitals of Seoul National University (A, B, and C) was carried out between 12 October 2006, and 31 January 2008. Bevacizumab was retrieved multiple times from a single original vial as needed and then discarded on the same day at hospital A and C, or prepared as a single dose aliquot vial at a compounding pharmacy in the hospital B. RESULTS: The incidence of endophthalmitis after IVBI was 2/2020 (0.099%). Two patients receiving IVBI on the same day, but by different surgeons in different sites in hospital B, developed acute endophthalmitis. S. marcescens was isolated from the vitreous sample of the two patients. Molecular typing with pulsed field gel electrophoresis showed that the organisms were of the same strain, which suggested that the drug was contaminated at the pharmacy. CONCLUSIONS: Endophthalmitis is a rare complication after IVBI and can be caused by contaminated aliquot drug. Serratia is one of the causative organisms of acute endophthalmitis, which can have devastating consequences, despite the treatment. A compounding pharmacy in a hospital might not be able to guarantee that aliquoted drug is free of contamination for the IVBI.