HIV-Negative Case of Talaromyces marneffei Pulmonary Infection with Liver Cirrhosis in China: A Case Report and Literature Review.

Background: Talaromyces marneffei (TM) is the third most prevalent opportunistic infection in HIV-positive patients after tuberculosis and cryptococcosis. However, such infection of non-HIV individuals has rarely been reported. Case Presentation: We describe a very rare case of a 52-year-old male who presented with a single space-occupying lesion on the right lung and was eventually diagnosed with pulmonary TM infection. The patient was HIV-negative and had liver cirrhosis with portal vein thrombosis. Lung tissue next-generation sequencing (NGS) revealed TM infection. We successfully treated the patient with voriconazole for 8 weeks and observed lesion absorption via subsequent CT. The patient consumed wild bamboo rats two months before admission. Mutations related to congenital immune deficiency were not detected by whole-exome sequencing. Conclusion: Early and timely diagnosis is critical for improving patient prognosis. NGS plays a vital role in the diagnosis of pulmonary TM infection in patients. To our knowledge, this is the first published case of pulmonary TM infection in an HIV-negative patient with liver cirrhosis.

[Mechanism of traditional Chinese medicine in treating ulcerative colitis-related colorectal cancer by regulating NF-κB-related signaling pathways: a review].

Ulcerative colitis is a chronic, recurrent, and nonspecific intestinal inflammatory disease, which is difficult to cure and has the risk of deterioration into related tumors. Long-term chronic inflammatory stimulation can increase the risk of cancerization. With the signaling pathway as a key link in the regulation of tumor microenvironments, nuclear factor-kappa B(NF-κB) is an important regulator of intestinal inflammation. It can also be co-regulated as downstream factors of other signaling pathways, such as TLR4, MAPK, STAT, PI3K, and so on. At present, a large number of animal experiments have proved that traditional Chinese medicine(TCM) can reduce inflammation by interfering with NF-κB-related signaling pathways, improve intestinal inflammation, and inhibit the progression of inflammation to tumors. This article reviewed the relationship between NF-κB-related signaling pathways and the intervention mechanism of TCM, so as to provide a reference for the clinical treatment of ulcerative colitis and the optimization of related cancer prevention strategies.

Loneliness, Living Alone, and Risk of Cardiovascular Disease Among Older Adults in China.

BACKGROUND: Older adults are prone to live alone and feel lonely. The main objective of this study was to assess the associations of loneliness and living alone with cardiovascular disease (CVD) among community-dwelling older individuals in China. METHODS: We conducted a longitudinal analysis on 3 661 participants aged older than 65 years from the latest 2014 and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Cox proportional hazards models were used to assess the associations of loneliness and living alone with CVD risk, with adjustment for confounding factors. RESULTS: A total of 616 incident CVD cases were identified during follow-up. Participants who reported feeling lonely experienced a 28% increased risk of developing CVD after adjustment for sociodemographic characteristics, lifestyle factors, and baseline health status (adjusted hazard ratio [HR]: 1.28, 95% confidence interval [CI]: 1.01-1.62; ptrend = .046). In contrast, no significant association was observed between living alone and CVD risk. Subgroup analyses showed that among those individuals who lived alone, often feeling lonely doubled the risk of CVD compared to never being lonely (HR: 2.17, 95% CI: 1.20-3.93; ptrend = .007). CONCLUSIONS: Loneliness was an independent risk factor for CVD among Chinese older adults. Our findings underscore the importance of addressing loneliness in the prevention of CVD among older individuals, especially those who live alone.

Control effect of high aspherical lenticule in children and adolescents with low myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore the effect of high aspherical lenticule on controlling low myopia.METHODS: Prospective study. A total of 100 patients aged 7 to 12 years old with low myopia who visited our hospital from May 1 to 31, 2022 were collected. They were divided into two groups with 50 cases in each group according to the wishes of patients. The control group was given single vision glasses after optometry, while the study group was given high aspherical lenticule. The myopia progression(absolute value), axial length(AL)growth, transition rate to moderate myopia, and AL negative growth rate over 6 mo and 1 a were compared between the two groups.RESULTS: The myopia progression and the AL growth of study group was lower than that of the control group after 6 mo and 1 a(all P<0.001).The negative growth rate of AL after 6 mo of treatment was significantly higher than that of the control group(P<0.001). The transition rate to moderate myopia between the two groups was not statistically significant(P=0.62); while the transition rate to moderate myopia in the study group was significantly lower than that in the control group after wearing lens for 1 a(P<0.001), and there was no statistically significant difference in AL negative growth rate between the two groups(P=0.12). Compare with single vision glasses, high aspherical lenticule achieved an 88.2% control rate for low myopia progression over 6mo and a 90.0% control rate of AL growth. The control rate for low myopia to moderate myopia was 66.7%; while the control rate of myopia progression growth was 75.6% after wearing lens for 1a, the control rate of AL growth was 69.2%, and the control rate of the transition rate to moderate myopia was 88.9%.CONCLUSION: For children and adolescents aged 7 to 12 with low myopia, high aspherical lenticule was more effective than single vision glasses in controlling myopia, making it one of the optimal choices for myopia control.

Prospective prescription review system correlated with more rational PPI medication use, better clinical outcomes and reduced PPI costs: experience from a retrospective cohort study.

INTRODUCTION: Proton pump inhibitor (PPI) abuse poses an overwhelming threat to the allocation of medical resources and places a heavy burden on global medical expenses. In this study, we put forward our prospective prescription review system and evaluated the effects of this system on clinical outcomes, rational medication use and costs related to PPIs. METHODS: A retrospective cohort study was conducted in which the included patients were divided into a preintervention group (2019.10-2020.09) and a postintervention group (2020.10-2021.09). To reduce the bias of patients' baseline characteristics, the propensity score matching (PSM) method was employed. The primary endpoints were the incidence of stress ulcers (SUs), the improvement and cure rates of gastrointestinal haemorrhage, the defined daily dose (DDD), the drug utilization index (DUI) and the DDD/100 patient-days. The secondary endpoints included the types of unreasonable medication orders for PPIs, the PPI utilization rate and PPI costs. RESULTS: A total of 53,870 patients were included to evaluate the secondary endpoints, and 46,922 patients were paired by PSM and assessed to evaluate the primary endpoints. The number of PPIs used and PPI costs were significantly lower in the postintervention group than in the preintervention group (P < 0.001). The rationality evaluation results showed that the frequency of PPI use and the number of drug interactions were significantly higher in the preintervention group than in the postintervention group (P < 0.01). The proportion of patients taking oral PPIs was significantly increased in the postintervention group (29.30% vs. 34.56%, p < 0.01). For the utilization of PPIs both for prevention and treatment, the DUI and DDD/100 patient-days were substantially decreased in the postintervention group (P < 0.001 and P < 0.05, respectively). The incidence of SUs in the postintervention group was 44.95%, and that in the preintervention group was 51.93% (p < 0.05). CONCLUSION: The implementation of the prospective prescription review system on rational PPI use correlated with reduced PPI costs, more rational PPI medication use and better clinical outcomes, and this system is worthy of long-term implementation for further improvement of rational drug use.

Improving rice eating and cooking quality by enhancing endogenous expression of a nitrogen-dependent floral regulator.

Improving rice eating and cooking quality (ECQ) is one of the primary tasks in rice production to meet the rising demands of consumers. However, improving grain ECQ without compromising yield faces a great challenge under varied nitrogen (N) supplies. Here, we report the approach to upgrade rice ECQ by native promoter-controlled high expression of a key N-dependent floral and circadian clock regulator Nhd1. The amplification of endogenous Nhd1 abundance alters rice heading date but does not affect the entire length of growth duration, N use efficiency and grain yield under both low and sufficient N conditions. Enhanced expression of Nhd1 reduces amylose content, pasting temperature and protein content while increasing gel consistence in grains. Metabolome and transcriptome analyses revealed that increased expression of Nhd1 mainly regulates the metabolism of carbohydrates and amino acids in the grain filling stage. Moreover, expression level of Nhd1 shows a positive relationship with grain ECQ in some local main cultivars. Thus, intensifying endogenous abundance of Nhd1 is a promising strategy to upgrade grain ECQ in rice production.

Epidemiology of Clinically Significant Aspergillus Species from a Large Tertiary Hospital in Shanghai, China, for the Period of Two Years.

Background: Aspergillus species are becoming a major public health concern worldwide due to the increase in the incidence of aspergillosis and emergence of antifungal resistance. In this study, we surveyed all Aspergillus species isolated from aspergillosis patients in Zhongshan Hospital Fudan University, Shanghai, China, from 2019 to 2021. Methods: We characterized the susceptibility profiles of these Aspergillus species to medical azoles (voriconazole, itraconazole and posaconazole) using YeastOneTM broth microdilution system. To determine the underlying antifungal resistance mechanisms in azole-resistant A. fumigatus (ARAf) isolates, we characterized mutations in the cyp51A gene. Genotypic diversity of sampled A. fumigatus was investigated using CSP-typing. Results: A total of 112 Aspergillus isolates (81 A. fumigatus, 17 A. flavus, 5 A. niger, 2 A. terreus, 2 A. lentulus, 2 A. oryzae, 1 A. nidulans, 1 A. versicolor and 1 A. sydowii) from 105 patients diagnosed with aspergillosis (including proven or probable invasive aspergillosis, chronic pulmonary aspergillosis, allergic bronchopulmonary aspergillosis and cutaneous aspergillosis) were obtained. Eight isolates (7 A. fumigatus and 1 A. niger) from seven patients were either azole non-susceptible or non-wild type. Azole non-susceptible or non-wild type rate was 7.1%/isolate and 6.7%/patient analysed. Four ARAf harbored TR34/L98H mutation, whereas one carried TR46/Y121F/T289A allele. The 81 A. fumigatus isolates were spread across 8 CSP types with t01 to be the predominant type (53.1%). ARAf isolates were distributed over CSP types t01, t02, t04A and t11. Conclusion: Results from this study provided us with an understanding of the antifungal resistance and related characteristics of Aspergillus species in Eastern China. Further comparisons of our results with those in other countries reflect potential clonal expansion of A. fumigatus in our region. Further surveillance study is warranted to guide antifungal therapy and for epidemiological purposes.

Comorbidities are associated with self-reported sleep-disordered breathing and insomnia: a cross-sectional study from China.

PURPOSE: We aimed to examine the associations of comorbidities with self-reported sleep-disordered breathing (SDB) and insomnia among Chinese adults. METHODS: The study used data from a community-based cross-sectional survey performed in China in 2018-2020. Multivariable logistic regression models were used to analyze the associations of 12 comorbidities with SDB and insomnia. RESULTS: A total of 4329 Han Chinese adults aged ≥ 18 years were enrolled. Of these, 1970 (45.5%) were male, with a median age of 48 years (interquartile range: 34-59). Compared with the participants without any conditions, adjusted ORs for SDB and insomnia for those with ≥ 4 comorbidities were 2.33 (95% CI: 1.58, 3.43, P-trend < 0.001) and 3.89 (95% CI: 2.69, 5.64, P-trend < 0.001), respectively. Seven comorbidities (hypertension, hyperlipidemia, coronary heart disease (CHD), bone and joint disease, neck or lumbar disease, chronic digestive diseases, and chronic urological disease) were positively associated with both SDB and insomnia. Cancer and chronic obstructive pulmonary disease (COPD) were also independently associated with insomnia. Of all comorbidities, cancer was most strongly associated with insomnia (OR = 3.16; 95% CI: 1.78, 5.63; P < 0.001), and CHD was most strongly associated with SDB (OR = 1.77; 95% CI: 1.19, 2.64; P < 0.001). CONCLUSIONS: The findings showed that adults with an increasing number of comorbidities had higher odds for SDB and insomnia, which were independent of sociodemographic and lifestyle factors.

Knock out of amino acid transporter gene OsLHT1 accelerates leaf senescence and enhances resistance to rice blast fungus.

Plant amino acid transporters regulate not only long-distance transport and reallocation of nitrogen (N) from source to sink organs, but also the amount of amino acids in leaves hijacked by invading pathogens. However, the function of amino acid transporters in plant defense responses to pathogen infection remains unknown. In this study, we found that the rice amino acid transporter gene OsLHT1 was expressed in leaves and up-regulated by maturation, N starvation, and inoculation of the blast fungus Magnaporthe oryzae. Knock out of OsLHT1 resulted in development stage- and N supply-dependent premature senescence of leaves at the vegetative growth stage. In comparison with the wild type, Oslht1 mutant lines showed sustained rusty red spots on fully mature leaf blades irrespective of N supply levels. Notably, no relationship between the severity of leaf rusty red spots and concentration of total N or amino acids was found in Oslht1 mutants at different developmental stages. Disruption of OsLHT1 altered transport and metabolism of amino acids and biosynthesis of flavones and flavonoids, enhanced expression of jasmonic acid- and salicylic acid-related defense genes, production of jasmonic acid and salicylic acid, and accumulation of reactive oxygen species. OsLHT1 inactivation dramatically prevented the leaf invasion by M. oryzae, a hemi-biotrophic ascomycete fungus. Overall, these results establish a link connecting the activity of an amino acid transporter with leaf metabolism and defense against rice blast fungus.

Association between vitamin K intake and depressive symptoms in US adults: Data from the National Health and Nutrition Examination Survey (NHANES) 2013-2018.

Background: The relationship between vitamin intake and depression has attracted increasing attention. However, several studies examining such relationship among populations at different age groups have produced inconsistent findings. This study was aimed to investigate the cross-sectional association between vitamin K intake and depressive symptoms in US adults. Methods: We used the data from a nationally representative sample of 11,687 adults from the 2013 to 2018 National Health and Nutrition Examination Survey (NHANES). Vitamin K intake was assessed by the 24-h dietary recall at the first day. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9). Logistic regression and generalized additive model were used to examine the association between vitamin K intake and depressive symptoms. Results: The weighted prevalence of depressive symptoms was 10.2% (8.0% in men and 12.0% in women). We observed a significant inverse linear relationship between vitamin K intake and depressive symptoms in models adjusted for age, sex, race/ethnicity, marital status, educational status, family poverty income ratio (PIR), home status, body mass index (BMI), smoking status, physical activity, sleep disorders, hypertension, hyperlipidemia, and diabetes. The odds ratios (OR) (95% CI) for the highest compared with the lowest quartile of vitamin K intake was 0.68 (95% CI: 0.52, 0.89, p-trend < 0.05). The association was similar in subgroups stratified by age, sex, race/ethnicity, marital status, educational status, PIR, home status, BMI, smoking status, physical activity, sleep disorders, hypertension, hyperlipidemia, and diabetes. Conclusion: Vitamin K intake was inversely and independently associated with the odds of depressive symptoms in the US adults. Prospective studies are warranted to confirm our findings.

Localized Surface Plasmon-Enhanced Infrared-to-Visible Upconversion Devices Induced by Ag Nanoparticles.

Upconversion devices (UCDs) have motivated tremendous research interest with their excellent potential and promising application in photovoltaic sensors, semiconductor wafer detection, biomedicine, and light conversion devices, especially near-infrared-(NIR)-to-visible upconversion devices. In this research, a UCD that directly turned NIR light located at 1050 nm into visible light located at 530 nm was fabricated to investigate the underlying working mechanism of UCDs. The simulation and experimental results of this research proved the existence of the quantum tunneling phenomenon in UCDs and found that the quantum tunneling effect can be enhanced by a localized surface plasmon.

Association of Dietary Approaches to Stop Hypertension (DASH) diet with self-reported sleep-disordered breathing (SDB): a cross-sectional study from China.

Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet has been associated with sleep quality. However, its relationship with sleep-disordered breathing (SDB) remains unknown. This study aimed to explore the association between the DASH diet and SDB using data from a community-based survey among adults in Suzhou, Eastern China. We conducted a cross-sectional analysis of the Suzhou Food Consumption and Health Survey in 2018-2020. Dietary intake was measured by a validated FFQ. The association between the DASH diet and SDB was estimated by multivariable logistic regression analysis. In addition, subgroup analysis and sensitivity analysis were performed to reinforce our findings. A total of 3939 participants were included in the final analysis. Participants in the upper quintile of the DASH score consumed more fruits, vegetables, nuts and legumes, whole grains, and dairy products, and less Na, red/processed meats, and sweetened beverages. The OR for the highest compared with the lowest quintile of the DASH score was 0·68 (95 % CI 0·52, 0·88; Pfor trend = 0·004) for SDB after multivariable adjustment. Of the eight DASH components, vegetables, nuts and legumes, and dairy products were inversely associated with SDB. The associations were similar in subgroups by age, sex, BMI, smoking, alcohol drinking, hypertension, diabetes and hyperlipidaemia. Adherence to the DASH diet was independently associated with decreased odds of self-reported SDB. Our novel results expand previous findings on diet and sleep and suggest the possibility of improving SDB by enhancing diet quality.

Trends in blood pressure and hypertension among older adults and oldest-old individuals in China between 2008-2018.

The aim of this study was to assess the trends in blood pressure (BP) levels and the corresponding prevalence of hypertension among elderly individuals in China from 2008 to 2018. This serial cross-sectional analysis was based on data from the last four waves of the Chinese Longitudinal Healthy Longevity Survey (N = 38086). Linear regression analyses were performed to assess linear trends in mean systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP). Logistic regression was used to examine trends in the prevalence of hypertension across the four waves. An ordinal regression model was used to assess risk factors for BP status. From 2008 to 2018, an increase of 0.8-3.3% in BP and at least an 8.2% increase in the prevalence of hypertension were observed among older adults and oldest-old adults (aged 65-79 years and ≥ 80 years) (all Ptrend < 0.001). Furthermore, the increasing magnitude of the prevalence of hypertension in the participants aged 65-79 years was greater than that in those aged ≥ 80 years. Region, BMI and living alone were factors associated with different BP statuses. After adjustment for demographic and behavioral characteristics, an increasing trend in mean SBP and PP was found in both men and women, whereas the mean DBP increased only in men. A significant increase occurred in hypertension prevalence, SBP and PP, whereas DBP remained stable in elderly Chinese individuals from 2008 to 2018. Comprehensive strategies need to be implemented for the prevention and management of hypertension among older adults in China.

Unraveling the Strong Fluorescence Enhancement of HPBI Molecules by ZIF-8 Colloidal Suspensions via Adsorption Analysis.

Enhancing the fluorescence of organic dye by colloidal particles is one of the most promising routes to optimize fluorescence detection. However, in addition to metallic particles, which serve as the most frequently used particles and have been found to employ the plasmonic resonance to provide strong fluorescence enhancement, neither new types of colloidal particles nor new fluorescence mechanisms have been intensively explored in recent years. In this work, strongly enhanced fluorescence was observed when 2-(2-hydroxyphenyl)-1H-benzimidazole (HPBI) molecules were simply mixed with zeolitic imidazolate framework-8 (ZIF-8) colloidal suspensions. Moreover, the enhancement factor ΔI = IHPBI+ZIF-8/IHPBI does not increase accordingly with the increasing amount of HPBI. To find out how the strong fluorescence was triggered and affected by the amount of HPBI, multiple techniques were applied to analyze the adsorption behavior. By combining analytical ultracentrifugation with first-principles calculations, we proposed that HPBI molecules were adsorbed onto the surface of ZIF-8 particles coordinatively and electrostatically, depending on the concentration of HPBI molecules. The coordinative adsorption would result in a new kind of fluorescence emitter. The new fluorescence emitters tend to distribute on the outer surface of ZIF-8 particles periodically. The distance between each fluorescence emitter is fixed and much smaller than the wavelength of the excitation light. Thus, it can be concluded that collective spontaneous emission might be triggered.

Short report: COVID-19 related knowledge, anxiety, and attitude towards the back-to-school arrangement among college students in China: a cross-sectional study.

The coronavirus disease 2019 (COVID-19) pandemic has been assumed to affect mental health of college students. The present cross-sectional study was conducted to examine levels of knowledge and anxiety about COVID-19, as well as attitude towards the back-to-school arrangement among college students in China in May 2020. A total of 716 students (312 males, 404 females) were included. Only 38.1% of the participants showed good knowledge about COVID-19. Moderate and severe anxiety was observed among 7.6% of the students. There were 15.6% of the participants opposing the back-to-school arrangement. Female students had more risk of having anxiety symptoms and negative attitude towards the back-to-school arrangement (p < 0.05). In addition, the level of anxiety was positively associated with the negative attitude towards the back-to-school arrangement (r = 0.11, p < 0.05). We therefore suggest that health education and psychological interventions should be given to college students, especially females and those without health-related backgrounds during the COVID-19 pandemic.

Family resilience of patients requiring long-term care: A meta-synthesis of qualitative studies.

BACKGROUND: Long-term care of patients with chronic illnesses is an important global public health issue, compromising the well-being of family members and the family functioning. Previous studies have examined the interactive experiences and processes of various systems in the families coping with long-term care stress; however, these studies have not been systematically reviewed and integrated. AIMS: This review aimed to synthesise the existing qualitative evidence on the experiences and processes of family resilience operate in families providing long-term care for patients with chronic illnesses and to provide suggestions for the development of interventions in future studies. MATERIALS & METHODS: We searched databases including PubMed, CINAHL, EMBASE, Web of Science, ProQuest and CNKI from their inception to March 2022. We used the JBI Critical Appraisal Tool for qualitative studies to evaluate the quality of the included studies was evaluated according to. We followed The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. The results were integrated using the thematic and content analysis method. RESULTS: Fourteen studies from eight countries covering 11 diseases reported on the experiences and coping processes of long-term care families. Based on McCubbin's Resiliency Model of Family Stress, Adjustment and Adaptation (FAAR), five analytical themes were synthesised: stressors (risk factors), family belief system, internal family coping strategies, external support and resilient adaptation indicators; the relationships between themes and subthemes were illustrated. DISCUSSION: This review synthesized qualitative evidence on the experiences and processes of family resilience operate in families providing long-term care. The results of this study found that the cognition and belief of family members regarding dilemmas have a two-way effect and act on the adaptation process of family members. In family adaptation, spirituality, hope, internal and external support are extremely important. In 14 studies, caregivers were from different countries with intercultural differences, but due to less reports on this content, it is difficult to compare the differences or impact that culture or ethnicity may have. CONCLUSIONS: Family resilience plays an important role in coping with stressors associated with the long-term care of a loved one through family belief systems, internal support systems and external support systems. The development of family resilience-based interventions for long-term care families should consider the family as a whole and further construct a multidisciplinary, multilevel and multi-type social support network to enhance family resilience.

Aqueous extract of Artemisia capillaris improves non-alcoholic fatty liver and obesity in mice induced by high-fat diet.

Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases and is a nutritional metabolic disease. Artemisia capillaris (AC) is the above-ground dried part of Artemisia capillaris Thunb. or Artemisia scoparia Waldst. et Kit., a natural medicinal plant with pharmacological effects of heat-clearing and biliary-promoting. In order to evaluate the therapeutic effect of Artemisia capillaris on NAFLD and obesity, experiments were conducted using aqueous extracts of Artemisia capillaris (WAC) to intervene in NAFLD models in vivo and in vitro. In vivo experiments were performed using HFD-fed (high fat diet) C57BL/6 mice to induce NAFLD model, and in vitro experiments were performed using oleic acid to induce HepG2 cells to construct NAFLD cell model. H.E. staining and oil red O staining of liver tissue were used to observe hepatocytes. Blood biochemistry analyzer was used to detect serum lipid levels in mice. The drug targets and mechanism of action of AC to improve NAFLD were investigated by western blotting, qRT-PCR and immunofluorescence. The results showed that C57BL/6 mice fed HFD continuously for 16 weeks met the criteria for NAFLD in terms of lipid index and hepatocyte fat accumulation. WAC was able to reverse the elevation of serum lipid levels induced by high-fat diet in mice. WAC promoted the phosphorylation levels of PI3K/AKT and AMPK in liver and HepG2 cells of NAFLD mice, inhibited SREBP-1c expression, reduced TG and lipogenesis, and decreased lipid accumulation. In summary, WAC extract activates PI3K/AKT pathway, reduces SREBP-1c protein expression by promoting AMPK phosphorylation, and decreases fatty acid synthesis and TG content in hepatocytes. AC can be used as a potential health herb to improve NAFLD and obesity.

Integrating Multidisciplinary Individualized Medication Recommendations Into the Traditional Pharmacists' Consultation Method: A Retrospective Study Using Propensity Score Matching Analysis.

Chinese clinical pharmacists consider improving the quantity and quality of consultations to be an important task in providing better pharmaceutical care. To achieve this goal, we developed a clinical pharmacist consultation method using multidisciplinary individualized medication recommendations (MIMRs) and studied the effects of its implementation. A retrospective study of 812 clinical pharmacist-led consultations was conducted. In the pre-intervention group, medication advice was given based on the purpose of the consultation. In the post-intervention group, a consultation method using MIMRs was implemented, in which clinical pharmacists with specialties in anticoagulation, gastroenterology, and nutrition were asked to give individualized medication recommendations. Outcomes, including the effectiveness rate of consultations (ERC) and acceptance rate of consultations (ARC), were compared between the two groups using propensity score matching method. Patterns and numbers of consultations and individualized medication recommendations were also compared. The results showed that the ERC in the post-intervention group compared with the ERC in the pre-intervention group was 83.3% vs 74.0%, respectively (P < .05). Significant difference was also shown between the two groups in ARC (98.4% vs 92.2%, P < .05). The total number of consultations increased, as did the number of general consultations, multidisciplinary/difficult consultations, anti-infection consultations, and non-anti-infection consultations specifically. As a result, we proposed that the implementation of MIMRs can improve the effects of treatment and increase the number of consultations by pharmacists, which is worthy of further promotion to better serve physicians and patients.

Population genomics confirms acquisition of drug-resistant Aspergillus fumigatus infection by humans from the environment.

Infections caused by the fungal pathogen Aspergillus fumigatus are increasingly resistant to first-line azole antifungal drugs. However, despite its clinical importance, little is known about how susceptible patients acquire infection from drug-resistant genotypes in the environment. Here, we present a population genomic analysis of 218 A. fumigatus isolates from across the UK and Ireland (comprising 153 clinical isolates from 143 patients and 65 environmental isolates). First, phylogenomic analysis shows strong genetic structuring into two clades (A and B) with little interclade recombination and the majority of environmental azole resistance found within clade A. Second, we show occurrences where azole-resistant isolates of near-identical genotypes were obtained from both environmental and clinical sources, indicating with high confidence the infection of patients with resistant isolates transmitted from the environment. Third, genome-wide scans identified selective sweeps across multiple regions indicating a polygenic basis to the trait in some genetic backgrounds. These signatures of positive selection are seen for loci containing the canonical genes encoding fungicide resistance in the ergosterol biosynthetic pathway, while other regions under selection have no defined function. Lastly, pan-genome analysis identified genes linked to azole resistance and previously unknown resistance mechanisms. Understanding the environmental drivers and genetic basis of evolving fungal drug resistance needs urgent attention, especially in light of increasing numbers of patients with severe viral respiratory tract infections who are susceptible to opportunistic fungal superinfections.