Expansion and transmission dynamics of high risk carbapenem-resistant Klebsiella pneumoniae subclones in China: An epidemiological, spatial, genomic analysis.

AIMS: Carbapenem-resistant Klebsiella pneumonia (CRKP) is a global threat that varies by region. The global distribution, evolution, and clinical implications of the ST11 CRKP clone remain obscure. METHODS: We conducted a multicenter molecular epidemiological survey using isolates obtained from 28 provinces and municipalities across China between 2011 and 2021. We integrated sequences from public databases and performed genetic epidemiology analysis of ST11 CRKP. RESULTS: Among ST11 CRKP, KL64 serotypes exhibited considerable expansion, increasing from 1.54% to 46.08% between 2011 and 2021. Combining our data with public databases, the phylogenetic and phylogeography analyses indicated that ST11 CRKP appeared in the Americas in 1996 and spread worldwide, with key clones progressing from China's southeastern coast to the inland by 2010. Global phylogenetic analysis showed that ST11 KL64 CRKP has evolved to a virulent, resistant clade with notable regional spread. Single-nucleotide polymorphism (SNP) analysis identified BMPPS (bmr3, mltC, pyrB, ppsC, and sdaC) as a key marker for this clade. The BMPPS SNP clade is associated with high mortality and has strong anti-phagocytic and competitive traits in vitro. CONCLUSIONS: The high-risk ST11 KL64 CRKP subclone showed strong expansion potential and survival advantages, probably owing to genetic factors.

Molecular epidemiology and risk factors for carbapenem-resistant Enterobacteriaceae infections during 2020-2021 in Northwest China.

OBJECTIVES: Severe infection caused by Carbapenem-resistant Enterobacteriaceae (CRE) is a challenge for clinical anti-infective therapy, and clinical intervention to improve control of CRE is of great significance. The study aims to determine the molecular epidemiology and risk factors of CRE infections to provide evidence for effective control of nosocomial infection in patients with CRE. METHODS: A total of 192 non-repetitive CRE strains were collected from January 2020 to December 2021 in Northwest China. To explore the risk factors of CRE infection by univariate and Logistic regression analysis, 1:1 case-control study was used to select Carbapenem sensitive Enterobacteriaceae (CSE) infection patients at the same period as the control group. RESULTS: Among the 192 CRE strains, the most common isolates included Klebsiella pneumoniae (Kpn) and Enterobacter cloacae (Ecl). The CRE strain showed the lowest rate of resistance to amikacin at 58.3. 185 CRE strains carried carbapenemase resistance genes of concern in this study. KPC-2 (n=94) was the most common carbapenemase, followed by NDM-1 (n=69), NDM-5 (n=22) and IMP-4 (n=5). OXA-48 and VIM were not detected. And KPC-2 was the most common in all strains. Logistic regression analysis implicated days of invasive ventilator-assisted ventilation (OR=1.452; 95 % CI 1.250～1.686), antibiotic combination therapy (OR=2.149; 95 % CI 1.128～4.094), hypoalbuminemia (OR=6.137; 95 % CI 3.161～11.913), history of immunosuppressant use (OR=25.815; 95 % CI 6.821～97.706) and days of hospitalization (OR=1.020; 95 % CI 1.006～1.035) as independent risk factors associated with CRE infection. Age (OR=0.963; 95% CI 0.943～0.984) and history of hormone use (OR=0.119; 95 % CI 0.028～0.504) were protective factors for CRE infection (P < 0.05). CONCLUSIONS: The resistance of commonly used antibiotics in clinical is severe, and CRE strains mainly carry KPC-2 and NDM-1. Multiple risk factors for CRE infection and their control can effectively prevent the spread of CRE.

Phenotypic and Genotypic Characterization of Carbapenem-resistant Enterobacteriaceae: Data From a Longitudinal Large-scale CRE Study in China (2012-2016).

Background: Carbapenem-resistant Enterobacteriaceae (CRE) strains are a major threat to global health. The development of effective control measures requires more detailed phenotypic and genotypic characterization of CRE. Methods: CRE isolates were collected from 65 hospitals in 25 provinces across China between January 1, 2012, and December 31, 2016. The isolates were characterized by antimicrobial susceptibility testing and multilocus sequence typing. Genes encoding carbapenemases, mobilized colistin resistance (mcr-1), and ß-lactamases were detected by polymerase chain reaction and DNA sequencing. Results: A total of 1801 independent CRE isolates (1201 Klebsiella pneumoniae, 282 Escherichia coli, and 179 Enterobacter cloacae) were collected during the study period. Overall, 96.9%, 89.7%, 54.5%, 49.9%, and 40% of CRE strains were susceptible to colistin, tigecycline, amikacin, minocycline, and fosfomycin, respectively. Notably, 1091/1201 (91%) K. pneumoniae, 225/282 (80%) E. coli, and 129/179 (72%) E. cloacae harbored carbapenemase gene. K. pneumoniae carbapenemase (KPC) was predominant in K. pneumoniae (77%), whereas New Delhi metallo-ß-lactamase (NDM) was predominant in E. coli (75%) and E. cloacae (53%). The mcr-1 gene was detected in 13 NDM-carrying E. coli isolates (4.6%). Sequence type (ST)11 and ST167 were predominant among the 100 K. pneumoniae and 47 E. coli STs, respectively. KPC-ST11, which accounted for 64% of K. pneumoniae isolates, had higher levels of resistance than non-ST11 strains to aztreonam, fosfomycin, and amikacin (P < .001). The proportions of KPC and NDM enzymes in CRE increased from 2012 to 2016 (54%-59% and 12%-28%, respectively). Conclusions: The number of CRE strains harboring carbapenemase is increasing. KPC-ST11 K. pneumoniae, the predominant strain, shows a reduced susceptibility to most available antibiotics.

Higher serum level of myoglobin could predict more severity and poor outcome for patients with sepsis.

BACKGROUND: There have been sporadic case reports published focusing on myoglobin and sepsis. However, there are no systematic studies evaluating the correlation between myoglobin level and sepsis. This study investigated the correlation between the serum myoglobin level and the severity of septic patients. Next, we assessed the predictive value of the serum myoglobin level for the prognosis of septic patients. METHODS: Seventy septic patients were included and subdivided into the following 3 groups: sepsis group, severe sepsis group, and septic shock group. We collected blood samples at 0, 6, 12, 18, and 24hours after admission. The serum levels of myoglobin, C-reactive protein, and procalcitonin were analyzed. We also evaluated the levels of malondialdehyde, which is a biomarker for oxidative stress. RESULTS: The data indicate that the myoglobin level increased gradually within 24hours after admission. The median myoglobin levels of the sepsis, severe sepsis, and septic shock groups were 635.7, 903.6, and 1094.8µg/L, respectively (P<.05). The elevated myoglobin level was positively correlated with Sequential Organ Failure Assessment score, C-reactive protein, and procalcitonin level in septic patients. The increased myoglobin level was also associated with the mortality of septic patients. The Kaplan-Meier survival curves indicated that patients with high myoglobin levels had an elevated mortality rate. Moreover, an elevated myoglobin level indicated more oxidative stress. CONCLUSIONS: The myoglobin level can be detected in the early stage of sepsis and may serve as a potential biomarker for evaluating sepsis severity and further prognosis.

Comparing Different Anesthesia Methods on Anesthetic Effect and Postoperative Pain in Patients with Early Gastric Cancer during Endoscopic Submucosal Dissection.

Endoscopic submucosal dissection (ESD) is a minimally invasive technique to completely peel the pathological mucosa from the submucosa under endoscopy, which has been often utilized to treat early gastric cancer. During the operation, anesthesia is required to reduce the discomfort due to the complexity, high risk, and longtime operation of ESD. In this study, we compared different anesthesia methods on anesthetic effect and postoperative pain in patients (≥65 years old) with early gastric cancer during ESD. For this purpose, 60 patients with early gastric cancer who were more than 65 years old were selected from January 2019 to December 2021, where 30 patients treated with simple intravenous general anesthesia were divided into the simple group and 30 patients treated with intravenous combined inhalation general anesthesia were regarded as the composite group. The hemodynamic index, wake-up time, postoperative pain intensity, operation time, and the incidence of adverse reactions were compared between the two groups. For the hemodynamic index before incision, after incision, and at the end of the operation, the mean arterial pressure (MAP) in the composite group was higher than that in the simple group (P < 0.05) and the heart rate (HR) was lower than that in the simple group (P < 0.05). After the ESD operation, the wake-up time and visual analogue scale (VAS) in the composite group were lower than those in the simple group (P < 0.05). In addition, the ESD operation time and incidence of adverse reactions in the composite group was significantly lower than that in the simple group (P < 0.05). These results showed that intravenous combined inhalation general anesthesia had a good anesthetic effect, stable hemodynamics during ESD operation, and slight postoperative pain.

Future water security in the major basins of China under the 1.5 °C and 2.0 °C global warming scenarios.

Freshwater is an essential resource for human lives, agriculture, industry, and ecology. Future water supply, water withdrawal, and water security under the impacts of climate change and human interventions have been of key concern. Numerous studies have projected future changes in river runoff and surface water resources under climate change. However, the changes in the major water withdrawal components including agricultural irrigation water, industrial, domestic and ecological water withdrawal, as well as the balance between water supply and withdrawal, under the joint impacts of climate change and socio-economic development have been seldom investigated, especially at the basin and national scales. In this study, changes in surface water resources, agricultural irrigation water, industrial, domestic and ecological water withdrawal, as well as the balances between water supply and withdrawal, under the baseline climate (2006-2015), 1.5 °C and 2.0 °C warming scenarios (2106-2115) in the 10 major basins across China, were investigated by combining modelling and local census data. The results showed that water withdrawal exceeded water supply in the basins of Liao River, Northwest River, Hai River, Yellow River and Huai River in the baseline period. Under the 1.5 °C and 2.0 °C warming scenarios, the shortage of water resources would aggravate in the above-mentioned basins and the Songhua River basin. And the surplus of water resources would reduce substantially in the basins of Yangtze River, Southeast River and Pearl River. Overall, the difference between water supply and water withdrawal was 435.88 billion m3 during the baseline period, and would be 261.84 and 218.39 billion m3, respectively, under the 1.5 °C and 2.0 °C warming scenarios. This study provides a comprehensive perspective on future water security in the 10 major basins across China, has important implications for water resources management and climate change adaptation.

Chlorophene degradation by combined ultraviolet irradiation and ozonation.

Ozonation combined with UV irradiation (UV/O(3)) is an advanced oxidation technique that is very promising for the destruction of organic compounds in aqueous solution. In this study, chlorophene was chosen as a model substrate to investigate the effects of pH, initial substrate concentration, ozone dose, and UV light intensity in degradation experiments. The pseudo-first-order rate constant for total organic carbon (TOC) removal was 2.4 × 10(-2), 9.8 × 10(-4), and 6.4 × 10(-2) min(-1) for O(3), UV, and UV/O(3) treatment, respectively. Clearly, UV-enhanced ozonation leads to a synergetic increase in the overall degradation efficiency. Comparative experiments were performed to investigate the effect of the matrix (distilled water or sewage) on chlorophene removal. The organic compounds in sewage retarded the rate of chlorophene removal by 38%, probably by competitively reacting with the oxidizing agent and screening light. The compound 2-benzoylbenzo-1,4-quinone, benzo-1,4-quinone, hydroquinone and maleic acid were identified as primary intermediates by gas chromatography-mass spectrometry. The concentrations of acetic, formic and oxalic anions were detected by ion chromatography. A possible degradation pathway is proposed on the basis of the reaction products identified.

Self-contained Janus Aerogel with Antifouling and Salt-Rejecting Properties for Stable Solar Evaporation.

Janus structural interfacial vaporization by separating the solar absorber from the bulk working fluid has attracted tremendous attention due to its low heat losses and high solar conversion efficiency for desalination, water purification, energy generation, etc. However, a totally separated double-deck structure with a discontinuous interfacial transition and inefficient photothermic materials undermines its long-term use and large-scale practical exploitation. Herein, a low-cost Janus monolithic chitosan aerogel with continuous aligned run-through microchannels has been demonstrated to have a highly efficient photothermic effect on seawater desalination and wastewater purification. The top solar absorber layer enhances broadband light absorption and photothermal conversion efficiency via the multiple internal reflection of incident light in the aligned microchannels. Moreover, the insulating/hydrophilic bottom layer promotes water transportation and heat localization, and simultaneously prevents salt/fouling accumulation. As a result, a long-term solar vaporization rate of ∼1.76 kg m-2 h-1 is achieved, corresponding to a light-to-vapor efficiency of ∼91% under 1 sun irradiation. Notably, the large-vessel microchannels throughout the aerogel and favorable swelling property provide sufficient water replenishment and storage for completely isolating self-contained evaporation, illustrating an enhanced and time-extended self-contained solar steam generation. Such a low-cost bilayer aerogel with remarkable cycling stability in various fluids offers potential opportunities for freshwater production in remote rural areas.

Conformal Microfluidic-Blow-Spun 3D Photothermal Catalytic Spherical Evaporator for Omnidirectional Enhanced Solar Steam Generation and CO2 Reduction.

Solar-driven water evaporation and valuable fuel generation is an environmentally friendly and sustainable way for clean water and energy production. However, a few bottlenecks for practical applications are high-cost, low productivity, and severe sunlight angle dependence. Herein, solar evaporation with enhanced photocatalytic capacity that is light direction insensitive and of efficiency breakthrough by virtue of a three-dimensional (3D) photothermal catalytic spherical isotopic evaporator is demonstrated. A homogeneous layer of microfluidic blow spun polyamide nanofibers loaded with efficient light absorber of polypyrrole nanoparticles conformally wraps onto a lightweight, thermal insulating plastic sphere, featuring favorable interfacial solar heating and efficient water transportation. The 3D spherical geometry not only guarantees the omnidirectional solar absorbance by the light-facing hemisphere, but also keeps the other hemisphere under shadow to harvest energy from the warmer environment. As a result, the light-to-vapor efficiency exceeds the theoretical limit, reaching 217% and 156% under 1 and 2 sun, respectively. Simultaneously, CO2 photoreduction with generated steam reveals a favorable clean fuels production rate using photocatalytic spherical evaporator by secondary growth of Cu2 O nanoparticles. Finally, an outdoor demonstration manifests a high evaporation rate and easy-to-perform construction on-site, providing a promising opportunity for efficient and decentralized water and clean fuel production.

Detection of microRNA-200b may predict the inhibitory effect of gefitinib on non-small cell lung cancer and its potential mechanism.

The present study aimed to investigate the association and underlying mechanisms between microRNA-200b level and the inhibitory effect of gefitinib on non-small cell lung cancer. In total, 100 patients (43 males and 57 females; median age, 63 years) with advanced non-small cell lung cancer (NSCLC) were selected. All patients were administered with gefitinib orally (250 mg/day) and the effect of gefitinib was evaluated according to the Response Evaluation Criteria in Solid Tumors guidelines. Tumor tissue and plasma samples were collected prior to and subsequent to therapy. The microRNA-200b levels in tissues and plasma were determined by quantitative polymerase chain reaction (PCR). A549 cells were cultured in vitro and transfected with microRNA-200b mimic. Using Cell Counting Kit-8 assay, the proliferation inhibition detected was induced by 0.1 µM gefitinib in transfected or non-transfected A549 cells. Cell apoptosis and cell cycle progression were analyzed by flow cytometry and the migration of cells was observed by Transwell assay. In addition, mRNA and protein levels of insulin-like growth factor 1 receptor (IGF-1R), protein kinase B (AKT) and extracellular signal-related kinase (ERK), together with the phosphorylation of AKT and ERK in A549 cells, were determined by quantitative PCR and western blot analysis, respectively. The microRNA-200b levels in gefitinib-insensitive patients were decreased compared with gefitinib-sensitive patients. Transfection with microRNA-200b mimic increased the gefitinib induced proliferation inhibition, apoptosis and cell cycle arrest in A549 cells. Also, transfection with microRNA-200b mimic increased the migration inhibitory effect of gefitinib on A549 cells. Decreased IGF-1R expression together with reduced phosphorylation of AKT and ERK were observed following transfection of A549 cells with the microRNA 200b mimic. In conclusion, detection of microRNA-200b may predict the inhibitory effect of gefitinib on NSCLC. Upregulation of microRNA-200b led to the elevated sensitivity of glioma cells to gefitinib, and this effect may be explained as microRNA-200b being able to inhibit the expression of IGF-1R, thereby reducing the activation of downstream phosphoinositide 3-kinase/AKT and mitogen-activated protein kinase signaling pathways.