[Effects of rapid drug sensitivity testing for multidrug-resistant bacteria on the prognosis of patients with severe intra-abdominal infection]

Objective: To examine the clinical value of rapid detection of drug-resistant bacteria by immunochromatography and the effects of rapid detection on the prognosis of patients with severe intra-abdominal infection complicated by carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection. Methods: This was a retrospective cohort study. We analyzed clinical data of 73 patients with severe abdominal infections with sepsis or septic shock complicated by CRE bloodstream infection admitted to the general surgery department of Jinling Hospital between February 2022 and February 2023. Patients were divided into a colloidal gold immunochromatographic assay (GICA) group (17 patients) and conventional testing group (56 patients) based on whether a GICA for CRE had been performed on the patients' first blood culture sample during the diagnosis and treatment process. There were no statistically significant differences between the GICA and conventional testing groups in age ([55.9±17.3] vs. [47.6±16.4] years), sex ([16 men vs. one woman ] vs. [41 men vs. 15 women]), median Charlson comorbidity index (3.0[2.0,4.0] vs. 3.0[2.0, 4.8]), septic shock (10 vs. 39), or acute kidney injury (8 vs. 40) (all P>0.05). Both groups routinely underwent traditional bacterial identification and drug susceptibility testing. Additionally, patients in the GICA group were tested directly for positive blood cultures using a GICA carbapenemase test kit. The main outcomes were mortality rates on Days 28 and 90 after the first identification of CRE bloodstream infection in both groups. We also compared the microbial clearance rate, duration of hospitalization and intensive care unit stay, and time from onset of CRE bloodstream infection to initiation of targeted and appropriate antibiotics between the two groups. Results: The rate of microbial clearance of bloodstream infection was significantly greater in the GICA group than in the conventional testing group (15/17 vs. 34/56 [60.7%], χ2=4.476, P=0.034), whereas the 28-day mortality tended to be lower in the GICA than conventional testing group [5/17 vs. 44.6% [25/56], χ2=1.250, P=0.264). The 90-day mortality (8/17 vs. 53.6% [30/56], χ2=0.222, P=0.638), median duration of hospitalization (37.0 [18.0, 46.5] days vs. 45.5 [32.2, 64.8] days, Z=-1.867, P=0.062), and median duration of intensive care unit stay (18.0 [6.5, 35.0] days vs. 32.0 [5.0, 51.8] days, Z=-1.251, P=0.209). The median time between the onset of bloodstream infection and administration of antibiotics was 49.0 (38.0, 69.0) hours in the GICA group, which is significantly shorter than the 163.0 (111.8, 190.0) hours in the conventional testing group (Z=-5.731, P<0.001). The median time between the onset of bloodstream infection and administration of appropriate antibiotics was 40.0 (34.0, 80.0) hours in the GICA group, which is shorter than in the conventional testing group (68.0 [38.2, 118.8]) hours; however, this difference is not statistically significant (Z=-1.686, P=0.093). Conclusions: GICA can provide information on carbapenemase- producing pathogens faster than traditional drug sensitivity testing, enabling early administration of the optimal antibiotics. The strategy of 'carbapenemase detection first' for managing bacterial infection has the potential to improve prognosis of patients and reduce mortality rate.

[The effect of Herba Erigerontis Compound on epithelial dysplasia of leukoplakia and lichen planus]

OBJECTIVE

To explore the effective Chinese medicine to prevent and treat oral precancerous lesions,and study the clinical therapeutic effect of Erigerontis Compound and its cellular dynamic mechanism.

METHODS

Select 45 volunteers suffering from leukoplakia(LK) and lichen planus(LP)who were divided int treatment and control groups. Treatment group(TG) took Herba Erigrontis Compound capsule for 3 months, Control group(CG) received YUN ZHI Polysacchrodepepitide and vitamin A capsule The results of variation of clinical symptoms, histopathology,and proliferative cell nucleic antigen (PCNA) were observed and compared.

RESULTS

In 79.2% case the degree of epithelia dysplasia was decreased and the TG was less than that of CG; the positive cell counts of PCNA of TG fewer than that of CG obviously;the symptom of TG lessen. All of these of TG were better than that of CG.

CONCLUSION

Herba Erigerontis Compound Capsule can prevent and treat LK and LP confirmly. Its anticanceration mechanism is to affect actively the cellular dynamics.

[Ultramicrostructural observation on epithelial cell disdifferentiation in rat tongue carcinogenesis induced by 4NQO]

OBJECTIVE

To clarify epithelial cell ultramicrostructure changes in oral carcinogenesis.

METHODS

The epithelial cell ultramicrostructures in tongue carcinogenesis induced by 4-nitroquinoline-1-oxide (4NQO) were observed by transmission electron microscope.

RESULTS

With the progress of oral carcinogenesis, regular changes of epithelial cell were showed: decrease in tonofibril, keratohyaline granules, desmosome; and increase in mitochondria. The basement membrane was broken in some severe dysplasia (sDP) and was broken through by parts of cell processes in in situ carcinoma (ISC).

CONCLUSION

Oral carcinogenesis is a multistep process. Epithelial cell aberrant differentiation is showed by a decrease in the synthetic products of epithelium cell.

[Correlative analysis with proliferating cell nuclear antigen and bromodeoxyuridine on golden hamster carcinogenesis model]

The early diagnosis of carcinomatous conversion has special significance on increasing therapeutic effectivencess.Proliferating cell nuclearnatigen(PCNA),bromodexoyuridine(UrdU)(immunohistochemistry ways),and microscopic diagnosis were applied and observed on golden hamster cheek is pouch carcinogenisis model induced by dimethylbenzanthracene(DMBA) in order to seek simple,effective,leading and reliable diagnostic way.The results showed that three observable means had significant correlativity,and demonstrated that immunohistochemistry ways have practical value in diagnosis of carcinomatous conversion.This study suggests that PCNA and BrdU be more sensitive,simple and reliable,and hopeful methods of early diagnosis of carcinomatous conversion.

[The study of influencing cellular dynamics of gynostemma pentaphyllum on golden hamster cheek pouch premalignancy]

Studying premalignancy is an important field of conquering cancer.The aim to study the mechanics of oral mucosal premalignant formation and seek effective drug which could prevent and block cancer,Gynostemma Pentaphyllum(GP) was applies to block carcinomatous conversion of golden hamster cheek pouch by Salley's way.Using light microscopic observation and proliferating cell nuclear antigen(PCNA) as well as bromodeoxyuridine(BrdU)(PCNA AND BrdU are immunohistochemistry techniques),GPs effect was observed dynamically.We found that GP could delay the presence of leukoplakia and decrease the rate of presence as well as cancer-causing rate. The positive cells of taking drug group PCNA and BrdU were lower than model group significantly and in a lower condition all the time.It is illustrated that GP has the effect of preventing cancer and inhibiting cellular dysplasia.

[Correlative analysis with proliferating cell nuclear antigen,bromodeoxyuridine,and microscopic observation on golden hamster carcinogenesis model]

The early diagnosis of carcinomatous conversion has special significance on increasing effectiveness.Proliferating cell nuclear antigen(PCNA),bromodeoxyuridine(BRDU)(immunohistochemistry ways),and microscopic diagnosis were applied and observed on golden hamster cheek pouch carcinogenisis model induced by dimethybenzanthracene(DMBA) in order to seek simple,effective,leading and reliable diagnostic way.The results showed that three observable means had significant correlation,and demonstrated that immunohistochemistry ways practical value in diagnosis of carcinomatous conversion.This study suggests that PCNA and BRDU are more sensitive,simple and reliable,and two hopeful methods of early diagnosis of carcinomatous conversion.

[The light microscopic observing analysis of 12-item pathological features on golden hamster cheek pouch dysplasia]

Grading objectively serious degree of oral mucosal premalignancy has instructive significance to its outlook and effectiveness.In order to supply experimental foundation of diagnosis epithelial dysplasis accruately,the sample of golden hamster premalignancy induced by dimethyblenzanthracence(DMBA) were made and observed microscopically.The results were recorded one by one according to 12-item criteria of WHO.The results showed that 12-item criteria could summarized wholly the histopathological varied features in the every stage of epithelial dysplasia The frequency of occurrence of 12-itemcriterias suggests that the starting site of premalignancy be at the basal layer.Abnormal karyokinetic and mitogenic figures have special significance in the epithelial dysplasia of grading diagnosis and judging outlook.

[The study of cellular dynamic varied features on golden hamster cheek pouch premalignant model]

Researching the model of golden hamster cheek pouch premalignancy not only had significance on treating and preventing oral epithelial cancers,but also could furnish the reference material about other similar hidden tumors.In this study,immunohistochemistry ways(proliferation cell nuclear antigen-PCNA,bromodeoxyurdine-BRDU) combined with light and electric microscopic observation were applied to study cellular dynamic varied features on golden hamster cheek pouch premalignant model induced by dimethylbenzanthracence (DMBA).The results showed that both S-period cells and DAN's synthesis increased in the development of premalignancy,then,discovered the basis of cellular dynamics of the model.

[A study on change of proliferating cell nuclear (PCNA) during DMBA induce golden hamster cheek pouch carcinoma]

109 cases were studied by immunohistochemisty with anti-PCNA antibody specimens which dyed by PCNA immunohistochemistry were counted with net and morphology observed.The results indicated that:a few of PCNA-positive cells had been seen in the basal cells of normal epithelium. An increased percentage of PCNA-positive cells was found in dysplasia and carcinoma.The increase between every grade is of statistical significance(P<0.05).In slight dysplasia grade group,the percentage od PCNA-positive cells increasing between applying DMBA-six-weeks' group is of statistical significance(P<0.05),and hadn't found statistical difference among the other groups.It is demonstrated that PCMA is one of criteria which were observed cell reproduction reactivities during precarcinoma,and it is more sensitive than light microscopy.

[Teatment of oral lichen planus with chloroquine and triamcinolone-A]

In this study,single blind grouping method was applied to compare the effect of chloroquine and triamcinolone-A which were used to treat 360 cases of oral lichen planus.The results showed the effect of local injecting triamcinolone-A was better than that of taking chloroquine,and also was better than that of taking triamcinolone-A accompained of chloroquine.Therefore,they were two effective ways to cure OLP and worthy of wide use.

[Observation of the effectiveness of compound Gynostemma Pentaphyllum Mak in golden hamster cheek pouch's premalignancy]

Premalignant model was established successfully in this study.At the same time,we applied compound Gynostemma Pentaphyllum Mak to conduct experimental research to block development of oral mucosal premalignancy.The results showed from uniform to granular or verrucous leukoplakia,there was the stage in which Gynostemma Pentaphyllum Mak could block oral mucosal premalignancies.The group which was firstly given to Gynostemma Pentaphllum Mak then smeared was more advantageous than the one which firstly smeared then given to the same drug.The experimentation demonstrated that Gynostemma Pentaphyllum had the functions of preventing and resisting cancer.There will be applied prospect in preventing and treating oral mucosal premalignancy.We should make further research in the future.