The incidence of surgical site infections in China

Surgical site infections (SSIs) are a common type of healthcare-associated infection. We performed a literature review to demonstrate the incidence of SSIs in mainland China based on studies since 2010. We included 231 eligible studies with ≥30 postoperative patients, comprising 14 providing overall SSI data regardless of surgical sites and 217 reporting SSIs for a specific site. We found that the overall SSI incidence was 2.91% (median; interquartile range: 1.05%, 4.57%) or 3.18% (pooled; 95% confidence interval: 1.85%, 4.51%) and the SSI incidence varied remarkably according to the surgical site between the lowest (median, 1.00%; pooled, 1.69%) in thyroid surgeries and the highest (median, 14.89%; pooled, 12.54%) in colorectal procedures. We uncovered that Enterobacterales and staphylococci were the most common types of micro-organisms associated with SSIs after various abdominal surgeries and cardiac or neurological procedures, respectively. We identified two, nine, and five studies addressing the impact of SSIs on mortality, the length of stay (LOS) in hospital, and additional healthcare-related economic burden, respectively, all of which demonstrated increased mortality, prolonged LOS, and elevated medical costs associated with SSIs among affected patients. Our findings illustrate that SSIs remain a relatively common, serious threat to patient safety in China, requiring more action. To tackle SSIs, we propose to establish a nationwide network for SSI surveillance using unified criteria with the aid of informatic techniques and to tailor and implement countermeasures based on local data and observation. We highlight that the impact of SSIs in China warrants further study.

Distribution and characteristics of bacteria on the hand during oropharyngeal swab collection: Which handwashing points are affected?

AIMS

To identify the contaminated areas of the hand collection and analyse the distribution characteristics of bacteria in the hand after swab collection.

DESIGN

This study used a cross-sectional design.

METHODS

A cross-sectional study sampling 50 pairs of hands (sampling hand and auxiliary hand) of healthcare workers was performed. Ten samples were collected from each participant. The optimal hand hygiene rates and bacterial colony counts of the whole hand and different hand sections without hand hygiene were identified as the primary outcomes.

RESULTS

The optimal hand hygiene rates of the sampling hand and auxiliary hand were 88.8% (222/250) and 91.6% (229/250), respectively. The lowest optimal hand hygiene rates for the sampling hand and the auxiliary hand were both on the dorsal side of the finger and the dorsum of the hand (86.0%, 86.0% vs. 90.0%, 86.0%); the optimal hand hygiene rates for both sites of the sampling hand were 86.0% (43/50), and the optimal hand hygiene rates for the auxiliary hand were 90.0% (45/50) and 86.0% (43/50). The bacteria colony counts did not differ between the sampling hands and auxiliary hand.

CONCLUSIONS

The dorsal side of the finger and dorsum of the hand were the most likely to be contaminated during oropharyngeal swab collection. Therefore, it is essential to pay extra attention to hand hygiene care of these two sites during the collection process to minimize the risk of cross-contamination.

REPORTING METHOD

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study.

Detection of paralytic shellfish toxins by near-infrared spectroscopy based on a near-Bayesian SVM classifier with unequal misclassification costs

BACKGROUND

Paralytic shellfish poisoning caused by human consumption of shellfish fed on toxic algae is a public health hazard. It is essential to implement shellfish monitoring programs to minimize the possibility of shellfish contaminated by paralytic shellfish toxins (PST) reaching the marketplace.

RESULTS

This paper proposes a rapid detection method for PST in mussels using near-infrared spectroscopy (NIRS) technology. Spectral data in the wavelength range of 950-1700 nm for PST-contaminated and non-contaminated mussel samples were used to build the detection model. Near-Bayesian support vector machines (NBSVM) with unequal misclassification costs (u-NBSVM) were applied to solve a classification problem arising from the fact that the quantity of non-contaminated mussels was far less than that of PST-contaminated mussels in practice. The u-NBSVM model performed adequately on imbalanced datasets by combining unequal misclassification costs and decision boundary shifts. The detection performance of the u-NBSVM did not decline as the number of PST samples decreased due to adjustments to the misclassification costs. When the number of PST samples was 20, the G-mean and accuracy reached 0.9898 and 0.9944, respectively.

CONCLUSION

Compared with the traditional support vector machines (SVMs) and the NBSVM, the u-NBSVM model achieved better detection performance. The results of this study indicate that NIRS technology combined with the u-NBSVM model can be used for rapid and non-destructive PST detection in mussels. © 2023 Society of Chemical Industry.

[Bioinformatics analysis of primary biliary cholangitis key genes and molecular mechanisms]

Objective: To extract the differentially expressed key genes of primary biliary cholangitis (PBC) using bioinformatics methods, so as to provide information for further study into the mechanism. Methods: The GSE119600 dataset was downloaded from the GEO database to obtain differentially expressed genes. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed for differentially expressed genes. Protein-protein interaction (PPI) network reconstruction, Cytoscape software visualization, and core gene screening were performed. The area under the receiver operating characteristic curve (ROC AUC) was used to assess the diagnostic effectiveness of genes and plot the pROC software package. The x-Cell software was used to calculate the enrichment score of 34 immune cells in each sample. Finally, four key genes (PSMA4, PSMA1, PSMB1, and PSMA3) were selected. Blood samples were analyzed using the qPCR method. Results:: A total of 373 immune-related differentially expressed genes were identified. Eight genes (PSMC6, PSMB2, PSMB1, PSMA3, PSMA4, PSMA1, PSMD7, and PSMB5) were screened from the 178 nodes and 596 edges as hub genes of the PPI network, which were significantly related to amino acid metabolism, hematopoietic stem cell differentiation, cell cycle, and immune processes. PSMA4, PSMA1, PSMB1, and PSMA3 were defined as immunological biomarkers for PBC with an AUC value of the ROC curve > 0.7. Immunoinfiltrating cell analysis showed that the proportion of eosinophils was significantly higher in PBC patients compared to the control group, whereas the proportion of CD4+ memory T cells, plasma cells, Th2 cells, and cDC cells was significantly lower in PBC patients than the control group. Plasma cells were associated with all four immunological biomarkers. Seven PBC patients and seven healthy subjects were selected for peripheral blood qPCR validation, which demonstrates that PSMB1, PSMA3, PSMA1, and PSMA4 levels were significantly lower in PBC patients than healthy subjects, with a statistically significant difference. Conclusion:: Bioinformatics screened eight key genes, of which four were key immunological markers and may serve as a basis for clinical diagnosis and mechanism exploration.

SARS-CoV-2 and male infertility: from short- to long-term impacts

PURPOSE

The coronavirus 2019 (COVID-19) pandemic-caused by a new type of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-has posed severe impacts on public health worldwide and has resulted in a total of > 6 million deaths. Notably, male patients developed more complications and had mortality rates ~ 77% higher than those of female patients. The extensive expression of the SARS-CoV-2 receptor and related proteins in the male reproductive tract and the association of serum testosterone levels with viral entry and infection have brought attention to COVID-19's effects on male fertility.

METHODS

The peer-reviewed articles and reviews were obtained by searching for the keywords SARS-CoV-2, COVID-19, endocrine, spermatogenesis, epididymis, prostate, and vaccine in the databases of PubMed, Web of Science and Google Scholar from 2020-2022.

RESULTS

This review summarizes the effects of COVID-19 on the male reproductive system and investigates the impact of various types of SARS-CoV-2 vaccines on male reproductive health. We also present the underlying mechanisms by which SARS-CoV-2 affects male reproduction and discuss the potentially harmful effects of asymptomatic infections, as well as the long-term impact of COVID-19 on male reproductive health.

CONCLUSION

COVID-19 disrupted the HPG axis, which had negative impacts on spermatogenesis and the epididymis, albeit further investigations need to be performed. The development of vaccines against various SARS-CoV-2 variations is important to lower infection rates and long-term COVID risks.

Multi-Model Strategies for Prevention of Infection Caused by Certain Multi-Drug Resistant Organisms in A Rehabilitation Unit: A Semi-Experimental Study

Objective: To assess the effectiveness of multi-model strategies on healthcare-associated infections (HAIs) caused by multi-drug resistant organisms (MDROs) in rehabilitation units. Methods: A semi-experimental study was conducted in a rehabilitation unit with 181 beds from January 2021 to December 2022 in a teaching hospital with 4300 beds in China. In 2021, many basic prevention and control measures were conducted routinely. Based on the basic measures, strengthening multi-model strategies for the prevention and control of MDROs was pursued year-round since 1 January 2022. Results: A total of 6206 patients were enrolled during the study period. The incidence density of HAIs caused by MDROs decreased from 1.22 (95% CI, 0.96~1.54) cases/1000 patient-days in the pre-intervention period to 0.70 (95% CI, 0.50~0.95) cases/1000 patient-days (p = 0.004). Similarly, the incidence of HAIs in the intervention period was 50.85% lower than that in the pre-intervention period (2.02 (95% CI, 1.50~2.72) vs. 4.11 (95% CI, 3.45-4.85) cases/100 patients, p < 0.001). The rate of MDROs isolated from the environment decreased by 30.00%, although the difference was not statistically significant (p = 0.259). Conclusion: Multi-model strategies can reduce the incidence of HAIs and HAIs caused by certain MDROs in the rehabilitation unit.

Surgical site infection following open lobectomy in patients with lung cancer: A prospective study

OBJECTIVE

To assess the incidence and risk factors of surgical site infection after open pulmonary lobectomy and to quantify their clinical and economic burden.

METHODS

A prospective nested case-control study was performed on patients with lung cancer who underwent open lobectomy in the lung cancer center of West China Hospital from January 2017 to December 2019. Demographic, clinical data and medical costs were recorded. Logistic regression was used to evaluate risk factors associated with surgical site infection. A Mann-Whitney U test was carried out to evaluate the differences in medical costs.

RESULTS

A total of 1395 patients were eligible, and the surgical site infection incidence was 13.47% (188/1395). Of the 188 instances of surgical site infection, 171 (90.96%) were classified as organ/space infection, 8 (4.25%) as superficial incisional infection and 9 (4.79%) as deep incisional infection. The patients with surgical site infection had significantly higher mortality (3.19% vs. 0.41%, p < 0.001), higher median medical cost (90774.95 yuan vs. 63079.38 yuan, p < 0.001), and longer postoperative length of stay (15 days vs. 9 days, p < 0.001). Multivariate logistic regression analysis indicated that age (odds ratio (OR) = 1.560, p = 0.007), respiratory failure (OR = 5.984, p = 0.0012), American Society of Anesthesiologists score (OR = 1.584, p = 0.005), operating time (OR = 1.950, p < 0.001), and operation team (OR = 1.864, p < 0.001) were independent risk factors for surgical site infection.

CONCLUSIONS

The high incidence of surgical site infection indicates that postoperative infections remain a significant clinical burden in patients who underwent open lobectomy. Identifying risk factors timely through prospective surveillance may assist clinical decisions against surgical site infection.

Identification of Perna viridis contaminated with diarrhetic shellfish poisoning toxins in vitro using NIRS and a discriminative non-negative representation-based classifier

Diarrhetic shellfish poisoning (DSP) toxins are one of the most widespread marine biotoxins that affect aquaculture and human health, and their detection has become crucial. In this study, near-infrared reflectance spectroscopy (NIRS) with non-destructive characteristics was used to identify DSP toxins in Perna viridis. The spectral data of the DSP toxin-contaminated and non-contaminated Perna viridis samples were acquired in the 950-1700 nm range. To solve the discrimination of spectra with crossover and overlapping, a discriminative non-negative representation-based classifier (DNRC) has been proposed. Compared with collaborative and non-negative representation-based classifiers, the DNRC model exhibited better performance in detecting DSP toxins, with a classification accuracy of 99.44 %. For a relatively small-scale sample dataset in practical applications, the performance of the DNRC model was compared with those of classical models. The DNRC model achieved the best results for both identification accuracy and F-measure, and its detection performance did not significantly decrease with decreasing sample size. The experimental results validated that a combination of NIRS and the DNRC model can facilitate rapid, convenient, and non-destructive detection of DSP toxins in Perna viridis.

Effect of daily chlorhexidine bathing on reducing infections caused by multidrug-resistant organisms in intensive care unit patients: A semiexperimental study with parallel controls

OBJECTIVE

To assess the effectiveness of daily bathing by chlorhexidine bathing on multidrug-resistant organisms in ICU, especially on carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Enterobacteriaceae (CRE).

METHODS

Semiexperimental study which employed both precontrols and a parallel control was conducted. In the intervention period (from July 1 to December 31, 2016), strengthened infection control measures and daily bathing with 2% CHG-impregnated wipes once daily was performed in the ICU. Fifty-seven non-ICU wards with the occurrence of multidrug-resistant organisms (MDRO) infections during the same time were selected as parallel control group (only CHG bathing was not performed). The net effect of the 2% CHG daily bathing was evaluated by the difference in difference (DID) model.

RESULTS

The DID model analysis showed that CHG bathing reduced the incidence of CRAB- and CRPA-caused infections in ICU by 1.56 and 2.15 cases/1000 patient days, and bathing of every 19 patients (95CI% 13 to 41) and 39 patients (95CI% 24 to 110) were able to prevent one case of HAIs of total MDROs and CRPA, respectively. However, CHG bathing showed no effect on MRSA, VRE, and CRE (p > 0.05).

CONCLUSION

Daily bathing with 2% CHG-impregnated wipes can reduce HAIs caused by CRAB and CRPA, while it is not effective for the prevalence of infections caused by MRSA, VRE, and CRE.

Analysis of risk factors associated with healthcare-associated carbapenem-resistant Klebsiella pneumoniae infection in a large general hospital: a case-case-control study

Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection is a major public health threat in the world. To inform the prevention and control of CRKP infection in hospitals, this study analyzed the factors associated with CRKP infection and resistance to carbapenems in K. pneumoniae. This case-case-control study was carried out in a large general hospital in China from January 2016 to December 2018, comprising 494 hospitalized patients infected with CRKP (case group 1) and 2429 hospitalized patients infected with carbapenem-susceptible K. pneumoniae (CSKP, case group 2). We selected control groups from hospitalized patients without K. pneumoniae infections for the two case groups separately, with a 1:3 case-control ratio, to analyze the risk factors of the two case groups using the conditional logistic regression. Multivariate analysis showed that the risk factors of CRKP infection were intensive care unit (ICU) admission (odds ratio [OR], 6.85; 95% confidence interval [CI], 4.90-9.58; P < 0.001), respiratory failure (OR, 1.93; 95% CI, 1.34-2.77; P < 0.001), age-adjusted Charlson comorbidity index (aCCI; OR, 1.08; 95% CI, 1.02-1.15; P = 0.007), admission from the Emergency (OR, 1.37; 95% CI, 1.02-1.85; P = 0.036), and imipenem use (OR, 1.80; 95% CI, 1.30-2.49; P < 0.001). Among the aforementioned five risk factors, aCCI (OR, 1.09; 95% CI, 1.06-1.13; P < 0.001) was also identified as a risk factor of CSKP infections in multivariate analysis. The risk factors for resistance to carbapenems in K. pneumoniae were ICU admission, respiratory failure, admission from the Emergency, and imipenem use.

[Clinical study of digital six-axis external fixation frame based on CT data for tibiofibular fractures]

Objective: To investigate the clinical effect of applying the digital six-axis external fixation frame based on CT data in the treatment of tibiofibular fractures. Methods: The clinical data of 43 patients with tibiofibular fractures treated by the self-developed digital six-axis external fixation frame based on CT data at Integrated Orthopedic Department of Traditional Chinese Medicine (TCM) and Western Medicine,HongHui Hospital from January 2018 to January 2021 were retrospective analysis.There were 27 males and 16 females,aged (36.0±9.4) years(range:25 to 50 years).AO classification:15 cases of 42A,11 cases of 42B, and 17 cases of 42C.There were 7 open fractures and Gustilo fracture classification:2 cases of type Ⅰ,4 cases of type Ⅱ,and 1 case of type Ⅲ.The two or three plane rings were connected with six connecting rods to form a complete six-axis external fixation frame,and the distal and proximal fracture blocks were connected to the distal and proximal rings by fixation pins,and the lengths of the six connecting rods needed to be adjusted were calculated by using the supporting software according to the CT data after surgery,and then the lengths of the connecting rods were adjusted one by one to complete the reduction of the fracture. The reduction accuracy of this six-axis external fixation brace was evaluated by measuring postoperative radiographs; postoperative recovery and complications were collected,the time of brace removal was recorded,and the function of the affected limb was evaluated according to the Johner-Wruhs score at the final follow-up. Results: Postoperative radiographs showed that all patients achieved satisfactory reduction with lateral displacement(M(IQR)) of 2.3(2.5) mm (range:0.3 to 7.3 mm),anteroposterior displacement of 2.1 (2.4) mm (range:0.3 to 5.7 mm),anteroposterior angulation of 2.5(2.4)°(range:0 to 5°),internal and external angulation of 2.1(1.5)°(range:0 to 4°), and no significant internal or external rotational deformity was detected on the exterior.On the second postoperative day,all patients were able to walk with partial weight-bearing on crutches. All 43 patients were followed up for more than 6 months,with a follow-up period of (33.3±7.3) weeks (range:24 to 42 weeks).The external fixation frame was removed after the fracture healed.The external frame was removed at 20(3)weeks (range:18 to 25 weeks) postoperatively. Up to the final follow up, no secondary fracture occurred in any of them.The Johner-Wruhs score of the affected limb at the last follow-up was excellent in 39 cases and good in 4 cases. Conclusion: The digital six-axis external fixator based on CT data for tibiofibular fractures has the advantages of precise reduction,firm fixation,simple operation,rapid fracture healing,and minimal trauma, which is a minimally invasive method for treating tibiofibular fractures,especially suitable for patients with poor skin and soft tissue conditions such as open injuries.

Compared hand hygiene compliance among healthcare providers before and after the COVID-19 pandemic: A rapid review and meta-analysis

Background

Hand hygiene (HH) is a cost-effective measure to reduce health care-associated infections. The overall characteristics and changes of hand hygiene compliance (HHC) among health care providers during the COVID-19 pandemic provided evidence for targeted HH intervention measures.

Aim

To systematically review the literature and conduct a meta-analysis of studies investigating the rate of HHC and the characteristics of HH during the COVID-19 pandemic.

Methods

The PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were searched. All the original articles with valid HHC data among health care providers during the COVID-19 pandemic (from January 1, 2020 to October 1, 2021) were included. Meta-analysis was performed using a DerSimonian and Laird model to yield a point estimate and a 95% CI for the HHC rate. The heterogeneity of the studies was evaluated using the Cochrane Q test and I² statistics and a random-effects model was used to contrast between different occupations, the WHO 5-moments of HH and different observation methods. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed.

Findings

Seven studies with 2,377 health care providers reporting HHC were identified. The estimated overall HHC was 74%, which was higher than that reported in previous studies (5%-89%). Fever clinic has become a new key place for HHC observation. Nurses had the highest HHC (80%; 95% CI:74%-87%) while auxiliary workers (70%; 95%CI:62%-77%) had the lowest. For the WHO 5-moments, the health care providers had the highest HHC after contact with the body fluids of the patients (91%; 95% CI:88%-94%), while before contact with patient's health care providers had the lowest HHC (68%; 95% CI:62%-74%) which was consistent with before the pandemic. There existed great HHC differences among different monitoring methods (automatic monitoring system:53%; 95% CI:44%-63% versus openly and secretly observation: 91%; 95% CI: 90%-91%).

Conclusions

During the COVID-19 pandemic, the compliance of health care providers’ HH showed a great improvement. The fever clinics have become the focused departments for HH monitoring. The HHC of auxiliary workers and the HH opportunity for “before contact with patients” should be strengthened. In the future, it will be necessary to develop standardized HH monitoring tools for practical work.

Rapid detection of mussels contaminated by heavy metals using near-infrared reflectance spectroscopy and a constrained difference extreme learning machine

The consumption of mussels contaminated with heavy metals can cause toxicity in humans. To realize quick, accurate, and non-destructive detection of heavy metals in mussels, a new method based on near-infrared reflection spectroscopy was developed in this study. Spectral data from 900 nm to 1700 nm of non-contaminated mussels and mussels contaminated with Cd, Zn, Pb, and Cu were collected using a near-infrared spectrometer. After pre-processing spectral data with multiplicative scatter correction, wavelength selection algorithms based on consistency measures of neighborhood rough sets were used to extract wavelengths for distinguishing non-contaminated and contaminated mussels. A constrained difference extreme learning machine was established as a classification model to detect contaminated mussels. In the proposed model, the weight and bias of the hidden layers are calculated by the difference vectors of samples between classes instead of being randomly selected. The results indicate that the proposed model performs significantly well in differentiating between non-contaminated and contaminated mussels. The average classification accuracy of 50 randomly generated test datasets reaches 97.53%, 95.67%, 99.00%, and 98.80% for the detection of Zn, Pb, Cd, and Cu contamination, respectively. This study demonstrates that near-infrared spectroscopy coupled with a constrained difference extreme learning can be used to rapidly and accurately detect mussels contaminated with heavy metals. This is of great significance for the evaluation of the quality and safety of mussels.

Analysis of healthcare-associated infection in patients with pulmonary arterial hypertension associated with congenital heart disease in PICU: Evidence from a tertiary hospital in western China

OBJECTIVE

The present study intends to analyze the targeted surveillance and risk factors for healthcare-associated infection (HAI) in patients with pulmonary arterial hypertension associated with congenital heart disease (CHD-PAH) in a Pediatric intensive care unit (PICU), and provide basis for formulating relevant prevention and control measures of HAI.

METHODS

Children (≤14 years old) who were admitted to the PICU for ≥2 calendar days from January 2018 to December 2021 were included. Targeted surveillance of HAI was described.

RESULTS

A total of 7,828 patients in PICU were monitored, and the total hospitalization days of the patients were 36,174. 108 cases of HAI occurred, with a per-case infection rate of 1.38% and a per-thousand day infection rate of 2.99. 1,129 patients with CHD-PAH were included, among which the total hospitalization days were 1,483. In this subpopulation, 38 cases of HAI were diagnosed, with a per-case infection rate of 3.37% and a per-thousand day infection rate of 25.62. The main site of HAI was lower respiratory tract (43.51%), followed by blood infection (34.26%) and surgical site infection (9.26%). 36 strains of pathogenic bacteria were detected from patients with HAI. The top three pathogens with the highest detection rate were Klebsiella pneumoniae (6 episodes, 16.67%), Enterococcus faecium (6 episodes, 16.67%) and Acinetobacter baumannii (4 episodes, 11.11%). The incidence of VAP, CAUTI and CLABSI was 2.78, 0.08 and 1.66 per 1,000 catheter days respectively. Analysis revealed that patients with CHD-PAH were younger and prone to receive surgical corrections. CHD-PAH could significantly increase the length of ICU stay, ventilator days, times of central venous catheterization and central venous catheterization days. The choice of different central venous catheter types differed significantly between the two groups.

CONCLUSION

Patients with CHD-PAH are characterized with excessive central venous catheterization operations, prolonged indwelling time, and more types of catheterization, which are considered to be risk factors for HAI, thus increasing the length of hospital stay. The clinical etiology is mainly G-bacteria, which requires reasonable selection of antibiotics and strict aseptic operation. Limiting unnecessary invasive procedures is helpful for reducing the incidence of postoperative HAI in PICU.

Comprehensive evaluation of genetic variants using chromosomal microarray analysis and exome sequencing in fetuses with congenital heart defect

OBJECTIVE

To evaluate comprehensively, using chromosomal microarray analysis (CMA) and exome sequencing (ES), the prevalence of chromosomal abnormalities and sequence variants in unselected fetuses with congenital heart defect (CHD) and to evaluate the potential diagnostic yields of CMA and ES for different CHD subgroups.

METHODS

This was a study of 360 unselected singleton fetuses with CHD detected by echocardiography, referred to our department for genetic testing between February 2018 and December 2019. We performed CMA, as a routine test for aneuploidy and copy number variations (CNV), and then, in cases without aneuploidy or pathogenic CNV on CMA, we performed ES.

RESULTS

Overall, positive genetic diagnoses were made in 84 (23.3%) fetuses: chromosomal abnormalities were detected by CMA in 60 (16.7%) and sequence variants were detected by ES in a further 24 (6.7%) cases. The detection rate of pathogenic and likely pathogenic genetic variants in fetuses with non-isolated CHD (32/83, 38.6%) was significantly higher than that in fetuses with isolated CHD (52/277, 18.8%) (P < 0.001), this difference being due mainly to the difference in frequency of aneuploidy between the two groups. The prevalence of a genetic defect was highest in fetuses with an atrioventricular septal defect (36.8%), ventricular septal defect with or without atrial septal defect (28.4%), conotruncal defect (22.2%) or right ventricular outflow tract obstruction (20.0%). We also identified two novel missense mutations (c.2447G>C, p.Arg816Pro; c.1171C>T, p.Arg391Cys) and a new phenotype caused by variants in PLD1.

CONCLUSIONS

Chromosomal abnormalities were identified in 16.7% and sequence variants in a further 6.7% of fetuses with CHD. ES should be offered to all pregnant women with a CHD fetus without chromosomal abnormality or pathogenic CNV identified by CMA, regardless of whether the CHD is isolated. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

[Early reduction of serum RANTES can predict HBsAg clearance in patients with chronic hepatitis B treated with nucleos(t)ide analogues combined with peginterferon alpha]

Objective: To observe the dynamic changes of serum RANTES during the treatment with nucleos(t)ide analogues combined with pegylated interferon alpha (peginterferon-α), and further analyze the predictive effect of RANTES on HBsAg clearance in patients with chronic hepatitis B. Methods: 98 cases of chronic hepatitis B with quantitative HBsAg < 3 000 IU/ml and HBV DNA < 20 IU/ml after≥1 year NAs treatment were enrolled. Among them, 26 cases continued to receive NAs monotherapy, 72 cases received NAs combined with pegylated interferon alpha therapy. The changes in RANTES during treatment were observed. The receiver operating characteristic curve was used to analyze the early changes of RANTES to predict the HBsAg clearance during 48 weeks. Results: During 48 weeks, 15 cases (20.83%) had achieved HBsAg clearance in combination group, while no patient had achieved HBsAg clearance in NAs group. The overall serum RANTES level had decreased from baseline in NAs and combination group. At week 48, in the combination group, the serum RANTES level was decreased more significantly in patients with HBsAg clearance than patients without. Further analysis showed that, in combination group, HBsAg clearance rate of patients with serum RANTES decreased at week 12 and 24 was higher than patients with elevated (29.17% vs. 4.17%, P = 0.014; 28.00% vs. 4.55%, P = 0.052), and quantitative HBsAg reduction was larger significantly [(1.49 ± 1.26) log(10)IU/ml vs. (0.73 ± 0.81) log(10)IU/ml, P = 0.017; (1.54 ± 1.27) log(10)IU/ml vs. (0.57 ± 0.56) log(10)IU/ml, P = 0.004]. Receiver operating characteristic curve analysis showed that the baseline quantitative HBsAg and the reduction in quantitative HBsAg and serum RANTES during the early period were predictors of HBsAg clearance after 48-week combination therapy. Furthermore, the combination of baseline quantitative HBsAg and 12 - or 24-week reduction of serum RANTES were better predictors of HBsAg clearance than that of baseline quantitative HBsAg combined with HBsAg decrease at week 12 or 24. The area under the receiver operating characteristic curve of the former was 0.925 and 0.939, while that of the latter was 0.909 and 0.929, respectively. Conclusion: Early reduction of serum RANTES at week 12 and 24 can predict HBsAg loss in CHB patients receiving addition of peginterferon-α to ongoing NAs Therapy, so serum RANTES could be one of the key immunological markers for predicting HBsAg clearance.

Development of a dynamic food chain model for assessment of the radiological impact from radioactive releases to the aquatic environment

The software tool POSEIDON-R was developed for modelling the concentration of radionuclides in water and sediments as well as uptake and fate in the aquatic environment and marine organisms. The software has been actively advanced in the aftermath of the Fukushima Dai-ichi accident. This includes development of an uptake model for the benthic food chain, a kinetic-allometric compartment model for fish and recent advancements for the application of ³H. This work will focus on the food chain model development and its extension to key artificial radionuclides in radioecology such as ³H. Subsequently, the model will be applied to assess the radiological dose for marine biota from ³H, ⁹⁰Sr, ¹³¹I, ¹³⁴Cs and ¹³⁷Cs released during and after the Fukushima Dai-ichi accident. The simulation results for ³H, ⁹⁰Sr, ¹³¹I, ¹³⁴Cs and ¹³⁷Cs obtained from the coastal box (4-4 km) located at the discharge area of the Fukushima Dai-ichi NPP, and the surrounding regional box (15-30 km) are compared with measurements. The predictions are by and large consistent with experimental findings, although good validation for ³H, ⁹⁰Sr and ¹³¹I is challenging due to lack of data. On the basis of the model predictions a dose assessment for pelagic and benthic fish is carried out. Maximum absorbed dose rates in the coastal box and the regional box are respectively 6000 and 50 μGy d^-1 and are found in the pelagic non-piscivorous fish. Dose rates exceeding ICRP's derived consideration levels of 1 mGy d^-1 are only found in the direct vicinity of the release and shortly after the accident. During the post-accidental phase absorbed dose rates consistently fall to levels where no deleterious effects to the marine biota are expected. The results also demonstrate the prolonged dose rate from ¹³⁴Cs and ¹³⁷Cs, particularly for benthic organisms, due to caesium's affinity with sediment, re-entry of caesium from the sediment into the food chain and external exposure from its high energetic gamma emissions. Uptake of non-organic tritium (HTO) and organically bound tritium (OBT) is modelled and shows some accumulation of OBT in the marine organism. However, dose rates from tritium, even during the accident, are low.

[Safety and efficacy of transcatheter tricuspid valve replacement with LuX-Valve in patients with severe tricuspid regurgitation]

Objectives: To evaluate the safety and efficacy of LuX-Valve on the treatment of severe tricuspid regurgitation (TR). Methods: This is a prospective observational study. From September 2018 to March 2019, 12 patients with severe TR, who were not suitable for surgery, received LuX-Valve implantation in Changhai Hospital. LuX-Valve was implanted under general anesthesia and the guidance of transesophageal echocardiography and X-ray fluoroscopy. Access to the tricuspid valve was achieved via a minimally invasive thoracotomy and transatrial approach. Main endpoints were surgery success and device success. Surgery success was defined as successful implanting the device and withdrawing the delivery system, positioning the valve correctly and stably without severe or life-threatening adverse events. Device success was defined as satisfied valve function (TR severity reduction ≥ 2 grades, tricuspid gradient ≤ 6 mmHg (1 mmHg=0.133 kPa)), absence of malposition, valve failure and reintervention, major adverse events including device related mortality, embolization, conduction system disturbances and new onset shunt across ventricular septum at day 30 post implantation. Results: A total of 12 patients with severe to torrential TR were included in this study. The age was (68.5±6.9) years and 7 were female. All patients had typical right heart failure symptoms. Procedural success was achieved in all cases, there was no intraprocedural mortality or transfer to open surgery. TR significantly improved after LuX-Valve implantation (none/trivial in 8 patients, mild in 3 patients and moderate in 1 patient). The average device time was (9.2±4.2) minutes. Intensive care unit duration was 3.0 (2.0, 4.8) days. One patient died at postoperative day 18 due to non-surgery and device reasons. Transthoracic echocardiography at 30 days after operation showed that TR was significantly reduced (none/trivial in 8 patients, mild in 2 patients and moderate in 1 patient) and device success was achieved in 11 cases. All survived patients experienced a significant improvement in life quality with significantly improvement in New York Heart Association (NYHA) classification (Ⅰ and Ⅱ: 6/11 post operation vs. 0/11 before operation, P=0.012) and there were no device related complications in this patient cohort. Conclusions: LuX-Valve implantation is feasible, safe and effective for the treatment of patients with severe TR.

Handwashing Sink Contamination and Carbapenem-resistant Klebsiella Infection in the Intensive Care Unit: A Prospective Multicenter Study

BACKGROUND

Handwashing sinks can become contaminated by carbapenem-resistant Klebsiella (CRK), including carbapenem-resistant Klebsiella pneumoniae (CRKP) and carbapenem-resistant Klebsiella oxytoca (CRKO), but whether they are major sources of CRK infections remains unknown.

METHODS

We performed a prospective multicenter study in 16 intensive care units (ICUs) (9 general and 7 neonatal) at 11 hospitals. All sinks at these locations were sampled to screen CRK. All CRK clinical isolates recovered between 2 weeks before and 3 months after sampling in ICUs with CRK-positive sinks or other participating ICUs at the same hospital were collected. Whole-genome sequencing of all isolates was performed. Isolates of the same sequence type (ST) were assigned to clones by calling single-nucleotide polymorphisms.

RESULTS

Among 158 sinks sampled, 6 CRKP and 6 CRKO were recovered from 12 sinks in 7 ICUs, corresponding to a 7.6% CRK contamination rate. Twenty-eight clinical isolates were collected, and all were CRKP. The 34 CRKP isolates belonged to 7 STs, including ST789 (n = 14, all had blaNDM-5); ST11 (n = 12, 5 belonged to KL64 and 7 to KL47, all had blaKPC-2); ST709 (n = 4, all had blaNDM-5); and ST16, ST20, ST1027, and ST2407 (n = 1 each). One particular ST789 clone caused an outbreak and contaminated a sink. ST11_KL47 sink isolates were likely the source of a cluster of clinical isolates. Two ST11_KL64 isolates belonged to a common clone but were from 2 hospitals.

CONCLUSIONS

Contaminated sinks were not the major source of CRK in our local settings. ST789 blaNDM-5-carrying CRKP might represent an emerging lineage causing neonatal infections.

Application of hyperspectral imaging technology for rapid identification of Ruditapes philippinarum contaminated by heavy metals

Combined with pattern recognition analysis hyperspectral imaging technology can be used to identify heavy metal contamination in Ruditapes philippinarum rapidly and non-destructively, even with only a small number of training samples.

Precise Species Identification and Taxonomy Update for the Genus Kluyvera With Reporting Kluyvera sichuanensis sp. nov

Kluyvera is a genus within the family Enterobacteriaceae and can cause various human infections but remains poorly studied. A carbapenem-resistant bla_NDM–1-carrying Kluyvera strain 090646^T was isolated from a hospital sink in Chengdu, Sichuan province, China. Whole genome sequencing of the strain revealed that it had 28.2 to 42.3% in silico DNA-DNA hybridization (isDDH) scores and 84.15 to 90.10% average nucleotide identity (ANI) values with other Kluyvera species. Both values are well below the ≥ 70.0% isDDH and ≥ 95–96% ANI cutoffs to define bacterial species, suggesting that the strain represents a novel species of the genus Kluyvera, for which the name Kluyvera sichuanensis. nov. is proposed. Type strain of K. sichuanensis is 090646^T (=GDMCC 1.1872^T =KCTC 82166^T). Strain 090646^T can be differentiated from other Kluyvera species by its ability to utilize D-sorbitol but not β-galactosidase (ONPG), D-mannose, glycerin, raffinose, nor sucrose. There were 47 genome sequences labeled as Kluyvera in GenBank, which were curated for precise species identification. Only 33 of the 47 genomes were indeed of Kluyvera and four novel Kluyvera genomospecies were identified, highlighting that the species assignation of bacterial genomes in GenBank need to be curated. Genome sequencing for more strains is required to understand the genus Kluyvera.

Risk factor for intestinal carriage of carbapenem-resistant Acinetobacter baumannii and the impact on subsequent infection among patients in an intensive care unit: an observational study

OBJECTIVES

To assess the incidence and the impact of carbapenem-resistant Acinetobacter baumannii (CRAB) intestinal carriage on subsequent CRAB infection and to study risk factors of acquiring CRAB intestinal carriage among patients in intensive care unit (ICU).

DESIGN

Observational study including a case-control study and a retrospective cohort study.

SETTING

A 50-bed general ICU of a university hospital, China.

METHODS

From May 2017 to April 2018, an observational study was conducted in a 50-bed general ICU of a university hospital in China. Rectal swabs were collected from ICU patients on admission and thereafter weekly. A case-control study was performed to analyse risk factors of the acquisition of CRAB intestinal carriage in ICU using multiple logistic regression. A retrospective cohort study was performed to address whether intestinal CRAB carriage could lead to an increased likelihood of subsequent CRAB infection using subdistribution hazard model regarding death in the ICU as a competing risk event.

RESULTS

CRAB intestinal carriage was detected in 6.87% (66/961; 95% CI 5.27% to 8.47%) of patients on ICU admission, whereas 11.97% (115/961; 95% CI 9.91% to 14.02%) of patients acquired CRAB intestinal carriage during the ICU stay. Pancreatitis (OR 2.16, 95% CI 1.28 to 3.67), haematological disease (OR 2.26, 95% CI 1.42 to 3.58), gastric tube feeding (OR 3.35, 95% CI 2.03 to 5.51) and use of carbapenems (OR 1.84, 95% CI 1.11 to 3.07) were independent risk factors for acquiring CRAB intestinal carriage. The incidence of subsequent CRAB infection was 2.24-fold in patients with CRAB intestinal carriage compared with that in patients without (95% CI 1.48 to 3.39, p<0.001).

CONCLUSION

More patients acquired CRAB intestinal carriage during their ICU stay than had on admission. Severity of illness, acute pancreatitis, tube feeding and use of carbapenems were independent risk factors of acquisition of CRAB intestinal carriage. Patients with CRAB intestinal carriage are more likely to develop CRAB infection.

Surface distribution of severe acute respiratory syndrome coronavirus 2 in Leishenshan Hospital in China

The global pandemic of Corona Virus Disease 2019 (COVID-19) necessitated the rapid construction of field hospitals as the main strategies to control the detrimental effects of the outbreak. Little is known about the extent of the environmental contamination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in an urgently field hospital. A total of 66 surface samples were randomly collected from a general isolation ward and an ICU (intensive care unit) at a rapidly built field hospital (Wuhan Leishenshan Hospital) in Wuhan, China, from 12 March to 17 March 2020. The samples were used for SARS-CoV-2 detection and ATP (adenosine triphosphate) monitoring. Among these samples, 3.03% tested positive for SARS-CoV-2. The nurses' hands and nurse station in the ICU were weakly positive (CT value = 38.79; CT value = 37.56) and the ATP value of these two sites was higher than the mean value of all samples (ATP = 817; ATP = 577). The environmental cleaning and disinfection normalization bundle measures in Leishenshan hospital included air disinfection, object surface cleaning and disinfection, instrument equipment surface disinfection and hand hygiene, etc. These have been tested and were shown to be reliable and useful. Our experience can provide a useful reference in the fight against the ongoing pandemic of COVID-19.

[Association between tooth missing and non-alcoholic fatty liver disease]

Objective: To evaluate the association between the number of teeth missed and the prevalence of non-alcoholic fatty liver disease (NAFLD) in adults. Methods: A cross-sectional study was carried out in 26 983 adults from Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study. The number of teeth missed (excluding third molars) was recorded and classified into four categories: 0, 1-, 3- and ≥6. NAFLD was diagnosed by at least two liver ultrasonography examinations. Adjusted multivariable logistic regression analysis was used to access the association between the number of missed teeth and NAFLD in adults. Results: The overall prevalence of NAFLD was 7 270 and the number of the subjects with at least one tooth missed was 9 667. The multivariable-adjusted ORs (95%CI) of NAFLD across the categories of tooth missing (0, 1-, 3- and ≥6) were as follows: 1.00, 1.04 (0.93-1.15), 1.08 (0.93-1.26) and 1.38 (1.09-1.76) (trend test P=0.030) in males; 1.00, 0.96 (0.82-1.12), 1.11 (0.91-1.35) and 1.22 (0.90-1.64) (trend test P=0.450) in females. Conclusion: The number of missed teeth was positively associated with a higher prevalence rate of NAFLD in males with over 6 teeth missed, but not in females.

Systematic analysis of copy-number variations associated with early pregnancy loss

OBJECTIVES

Embryonic numerical and structural chromosomal abnormalities are the most common cause of early pregnancy loss. However, the role of submicroscopic copy-number variations (CNVs) in early pregnancy loss is unclear, and little is known about the critical regions and candidate genes for miscarriage, because of the large size of structural chromosomal abnormalities. The aim of this study was to identify potential miscarriage-associated submicroscopic CNVs and critical regions of large CNVs as well as candidate genes for miscarriage.

METHODS

Over a 5-year period, 5180 fresh miscarriage specimens were investigated using quantitative fluorescent polymerase chain reaction/CNV sequencing or chromosomal microarray analysis. Statistically significant submicroscopic CNVs were identified by comparing the frequency of recurrent submicroscopic CNVs between cases and a published control cohort. Furthermore, genes within critical regions of miscarriage-associated CNVs were prioritized by integrating the Residual Variation Intolerance Score and the human gene expression dataset for identification of potential miscarriage candidate genes.

RESULTS

Results without significant maternal-cell contamination were obtained in 5003 of the 5180 (96.6%) cases. Clinically significant chromosomal abnormalities were identified in 59.1% (2955/5003) of these cases. Three recurrent submicroscopic CNVs (microdeletions in 22q11.21, 2q37.3 and 9p24.3p24.2) were significantly more frequent in miscarriage cases, and were considered to be associated with miscarriage. Moreover, 44 critical regions of large CNVs were observed, including 14 deletions and 30 duplications. There were 309 genes identified as potential miscarriage candidate genes through gene-prioritization analysis.

CONCLUSIONS

We identified potential miscarriage candidate CNVs and genes. These data demonstrate the importance of CNVs in the etiology of miscarriage and highlight the importance of ongoing analysis of CNVs in the study of miscarriage. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Carbapenem-resistant Isolates of the Klebsiella pneumoniae Complex in Western China: The Common ST11 and the Surprising Hospital-specific Types

A genome sequence-based analysis of 74 carbapenem-resistant Klebsiella pneumoniae (CRKP) from 12 hospitals in Sichuan, China, revealed that the isolates carried blaKPC-2 (n = 48), blaNDM (n = 22), or blaIMP-4 (n = 4) were identified as K. pneumoniae (n = 67), Klebsiella variicola (n = 5), and Klebsiella quasipneumoniae (n = 2) and belonged to 19 sequence types. Both inter- and intrahospital transmission of multiple ST11 strains was identified. There is an urgent need for all hospitals in a given region to coordinate actions against CRKP.

In-hospital Medical Costs of Infections Caused by Carbapenem-resistant Klebsiella pneumoniae

Background

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a major health threat, but the economic impact of carbapenem resistance in K. pneumoniae infections remains largely uninvestigated.

Methods

We constructed a retrospective cohort of all patients hospitalized at West China Hospital in 2017 who had CRKP- or carbapenem-susceptible K. pneumoniae (CSKP)-positive clinical samples. Propensity score matching (PSM) was used to control the impact of potential confounding variables, including demographics, comorbidities, and treatment, and to observe the impact of factors other than length of stay (LOS). Patients who survived were subjected to subgroup analyses stratified by infection type.

Results

There were 267 patients with CRKP and 1328 with CSKP. Patients with CRKP had a higher crude in-hospital mortality rate (14.61% vs 5.65%, P < .05) and longer LOS (median, 31 vs 19 days; P < .05). PSM for demographics, comorbidities, and treatment generated 237 pairs. Patients with CRKP had higher medical costs than those with CSKP during the entire hospitalization (median, in US dollars, $22962 vs $11755, respectively; P < .05) and during the period after infection (median, $9215 vs $6904, respectively; P < .05). When LOS was matched, patients with CRKP still had high excess costs compared to those with CSKP (median, $22917 vs $13851, respectively, for the entire hospitalization, P < .05; $9101 vs $7001, respectively, after infection, P < .05). For infection type, the sample size generated sufficient power to compare only the patients with pneumonia. For surviving patients, high excess costs were observed in those with pneumonia caused by CRKP as compared to CSKP ($21890 vs $11698, respectively, for the entire hospitalization, P < .05; $9773 vs $5298, respectively, after infection, P < .05). Medicines other than antibacterial agents and nonmedicinal therapies contributed most (57.8%) of the excess costs associated with CRKP.

Conclusions

Carbapenem resistance in K. pneumoniae was associated with increased medical costs not accounted for by the cost of antimicrobial therapy.

[Efficacy and peripheral immunity analysis of allogeneic natural killer cells therapy in patients with hepatocellular carcinoma]

OBJECTIVE

To evaluate the safety and efficacy of allogeneic natural killer (NK) cells in the treatment of primary hepatocellular carcinoma (HCC), and to elucidate the mechanism of NK cells therapy.

METHODS

Twenty-one patients with primary HCC treated with allogeneic NK cells at the Fifth Medical Center of the PLA General Hospital were followed up for 1 year. Peripheral blood mononuclear cells (PBMCs) were isolated from patient-related donors and cultured in vitro for 15 days and infused to the patients in two consecutive days. Clinical data and laboratory data were collected and analyzed, including survival, clinical features, imaging changes, hematology, immunology, and biochemical indicators to evaluate the safety and efficacy of allogeneic NK cell therapy. The changes of peripheral blood lymphocyte subsets after treatment were also analyzed to explore the possible anti-tumor mechanisms.

RESULTS

(1) Of the 21 patients with primary HCC, 11 patients were treated once, 5 patients were treated twice, and 5 patients were treated 3 times. After allogeneic NK cells infusion, 10 patients had fever, 1 patient had slight hepatalgia and 1 patient had slight headache, no other adverse events occurred including acute and chronic graft-versus-host disease (GVHD). They resolved spontaneously within 8 hours without other treatment. (2) The total disease control rate was 76.2% during one-year follow-up. Among them, the patients with Barcelona clinic liver cancer (BCLC) stage A had a disease control rate of 100%, stable disease (SD) in 10 cases; BCLC stage B patients had a disease control rate of 60%, partial response (PR) in 1 case, and SD 2 in cases; BCLC stage C patients had a disease control rate of 50%, complete response (CR) in 1 case, and 2 cases of PR. (3) The frequencies of NK cells and CD8+ T cells in peripheral blood were significantly lower than that before at 24 hours after treatment, and the frequencies of CD4+ T cells and CD4/CD8 were significantly higher than the baseline.

CONCLUSION

Allogeneic NK cells have good safety and efficacy in the treatment of primary HCC. The anti-tumor effect of the allogeneic NK cells may play an important role in the activation of the patient's natural immune system and delay disease progression, suggesting that allogeneic NK cells combined with sorafenib may be a very effective treatment for advanced HCC, and further large-sample multicenter randomized controlled clinical trials are needed to validate this result.

Screening and analysis on the differentially expression genes between diploid and autotetraploid watermelon by using of digital gene expression profile

Abstract Synthetic polyploids are key breeding materials for watermelon. Compared with diploid watermelon, the tetraploid watermelon often exhibit wide phenotypic differences and differential gene expression. Digital gene expression (DGE) profile technique was performed in this study to present gene expression patterns in an autotetraploid and its progenitor diploid watermelon, and deferentially expressed genes (DEGs) related to the abiotic and biotic stress were also addressed. Altogether, 4,985 DEGs were obtained in the autotetraploid against its progenitor diploid, and 66.02% DEGs is up-regulated. GO analysis shows that these DEGs mainly distributed in ‘metabolic process’, ‘cell’ and ‘catalytic activity’. KEGG analysis revealed that these DEGs mainly cover ‘metabolic pathways’, ‘secondary metabolites’ and ‘ribosome’. Moreover, 134 tolerance related DEGs were identified which cover osmotic adjustment substance, protective enzymes/protein, signaling proteins and pathogenesis-related proteins. This study present the differential expression of stress related genes and global gene expression patterns at background level in autotetraploid watermelons. These new evidences could supplement the molecular theoretical basis for the better resistance after the genome doubling in the gourd family.

Interpretation and clinical practice of regulation for prevention and control of healthcare associated infection in outpatient and emergency department in healthcare facilities

Healthcare associated infection (HAI) control and prevention is the important component of medical safety. Healthcare workers (HCWs) are the core forces for implementing good HAI control and prevention. Several cases of outbreaks occurred in outpatient and emergency department (OED) strengthened the importance of infection control and prevention. Recently, the "Regulation for prevention and control of HAI in outpatient and emergency department in healthcare facilities" was released by National health Commission of the People's Republic of China on May 10, 2018 and was going to implement on Nov 1, 2018. This regulation stipulates basic infection prevention requirements for safe care in OED of healthcare facilities. In this article, we would provide the interpretation and clinical practice of regulation for prevention and control of HAI in outpatient and emergency department in healthcare facilities and give a summary introduction.

Methicillin-resistant Staphylococcus aureus nasal colonization and infection in an intensive care unit of a university hospital in China

Objective This study was performed to determine the prevalence and risk factors associated with nasal methicillin-resistant Staphylococcus aureus (MRSA) colonization upon intensive care unit (ICU) admission and during the ICU stay in mainland China. Methods A prospective observational study was performed in a 50-bed general ICU of a 4300-bed teaching hospital in China from 2011 to 2013. Nasal swabs for MRSA detection were obtained upon ICU admission and at discharge for patients having stayed in the ICU for longer than 3 days. Results In total, 115 patients (4.1%; 95% confidence interval [CI], 3.4-4.9) were already colonized with MRSA on ICU admission, and another 185 patients (10.7%; 95% CI, 9.3-12.2) acquired MRSA during their ICU stay. Development of an MRSA infection was significantly more likely in patients with than without MRSA colonization on ICU admission (odds ratio [OR], 2.8; 95% CI, 1.1-7.3). Patients who acquired MRSA had significantly prolonged lengths of stay in the ICU (23.3 days) and higher hospital bills (135,171 RMB; about 19,590 USD) than those who tested negative for MRSA. Conclusion The MRSA colonization rate among ICU patients in mainland China is high. Patients with MRSA-positive nasal swabs are more likely to develop MRSA infections.

[Predictor measures on CT for hematoma expansion following acute intracerebral hemorrhage]

OBJECTIVE

To evaluate the worth of solid predictors in acute intracerebral hematoma(ICH) expansions in computer tomography images.

METHODS

A total of 105 patients with acute ICH in The Second Affiliated Hospital of Soochow University during January 2012 to February 2015 were enrolled. CT plain scan, CTA within 6 hours since the symptoms and CT plain scan recheck within 24 hours were executed. Hematoma location, initial volume of hematoma, shape of hematoma, "spot sign" , UHG speed were analyzed with single factor and binary Logistic regression between the patients with and without hematoma expansion.

RESULTS

There were 30 cases with hematoma expansion and 75 cases with no hematoma expansion in 105 patients. In single factor comparisons, hematoma location(χ(2) =13.125, P<0.05), hematoma shape(χ(2) =23.987, P<0.05), spot sign(χ(2) =25.846, P<0.05), UHG speed(χ(2) =20.328, P<0.05) and the initial hematoma volume(t=-3.183, P<0.05) between the hematoma expansions and the non-hematoma expansions made significant differences. In binary Logistic regression, hematoma shape(irregular (P=0.033) and cleavage(P=0.009)), spot sign(P=0.000) and UHG speed(P=0.040) had significant differences between the two groups. ROC curve areas of hematoma shape, spot sign and UHG speed were 0.776(95%CI 0.682-0.870), 0.740(95%CI 0.625-0.855) and 0.720(95% CI 0.604-0.836). The high specificities of hematoma shape(84%), spot sign (88%)and UHG speed(84%)revealed their great reliabilities with equal sensitivity (60%).

CONCLUSION

Hematoma shape, spot sign and UHG speed are solid predictors of hematoma expansion among which spot sign has promising specificity, hematoma shape and UHG speed are more convenient to be observed.

[Antibacterial and residual antimicrobial activities of five final irrigants in infected root canal: an in vitro comparative study]

OBJECTIVE

To evaluate antibacterial and residual antimicrobial activities of five root canal irrigants including Qmix, MTAD(mixture of a tetracycline isomer, an acid, and a detergent), 0.2% cetrimide(CTR), 2% chlorhexidine(CHX) and 17% ethylene diaminetetraacetic acid(EDTA) and to find the most optimal final irrigants for using in root canal therapy.

METHODS

The standard enterococcus infection models were built up in 100 single rooted incisors with single canal. Totally 30 teeth were selected by using random number tablefor detecting the quality of the bacteria model. Crown-down technique with rotary ProTaper system was used to prepare the root canals. Then the teeth were randomly divided into seven groups of which five groups were irrigated with five different irrigants respectively, one group was irrigated with distilled water(distilled water group) and one group was no-irrigation group. Each tooth was sectioned into three parts: apical 1/3, middle 1/3 and coronal 1/3. After irrigation, specimenswere cultivated from day 0 to day 14. All statistical analyses were performed by means of SPSS 17.0 software. Chi-squared test was used to evaluate antibacterial activities. Generalized estimating equations was used to evaluate residual antimicrobial activities.

RESULTS

All samples rinsed with Qmix, MTAD, CTR, CHX were bacteria-free in 0 day. The samples rinsed with EDTA and distilled water had no bacteria in 7 coronal sections, 6 middle sections and 9 apical sections, respectively. The results of Qmix, MTAD, CTR and CHX groups showed significant difference when compared with that of distilled water, EDTA and control groups(P<0.05). Residual antimicrobial resultsin EDTA, distilled water, no-irrigation groups showed significant differences compared with that of Qmix, MTAD, CTR, CHX groups according to pairwise comparison(P<0.05) on day 1, 2 and 3. There was no significant difference between the other two groups(P>0.05). Antimicrobial properties on the coronal 1/3 and apical 1/3, middle 1/3 and apical 1/3 showed significant difference(P<0.05) while middle 1/3 and coronal 1/3 showed no significant difference(P>0.05).

CONCLUSIONS

Qmix, MTAD, CTR and CHX had an antimicrobial activity, but could not destroy Enterococcus faecalis completely. Antimicrobial activity in coronal 1/3 was better than in apical 1/3. Qmix, MTAD, CTR and CHX had a residual antimicrobial activity with various lasting times. The lasting time of residual antimicrobial activity was as follow: MTAD> CTR>Qmix>CHX. EDTA had no antibacterial and residual antimicrobial activities.

[Prevalence of deep venous thrombosis in burn patients and its influencing factors]

OBJECTIVE

To investigate the prevalence of deep venous thrombosis (DVT) in burn patients, and to explore its influencing factors.

METHODS

Clinical data of 2 506 burn patients admitted to our ward from January 2009 to January 2014, conforming to the study criteria, were retrospectively analyzed. Patients were divided into DVT group (n=26) and non-DVT group (n=2 480) according to whether or not DVT occurred during hospitalization. The incidence of DVT was calculated. The diagnosis time and type of DVT were recorded. The data of gender, age, depth of burn, total burn area, location of injury, cause of injury, infection of wound, venous transfusion of fluid (hypertonic solution and blood), location of intravenous catheterization, skin grafting, timing of first skin grafting after injury, D-dimer, bedridden duration after injury among patients between two groups were compared with chi-square test and Wilcoxon test. Indexes with statistically significant differences between two groups were selected, and they were processed with multivariate logistic stepwise regression analysis to screen the independent risk factors of DVT.

RESULTS

(1) The incidence of DVT was 1.04% (26/2 506). The diagnosis time of DVT was 16-62(40±12)d, and patients diagnosed as having DVT after the 20th day post injury accounted for 92.3% (24/26). All DVT occurred in lower limbs, with 1 case of central type, 24 cases of peripheral type, and 1 case of mixed type. (2) There were no statistically significant differences in gender, location of injury (upper limbs, trunk, head and face), cause of injury, jugular vein catheterization, skin grafting, and timing of first skin grafting after injury among patients between two groups (with χ(2) values from 1.853 to 3.742, Z=3.342, P values above 0.05). There were statistically significant differences in age, depth of burn, total burn area, burn in lower limbs, infection of wound, venous transfusion of hypertonic solution and blood, femoral vein and subclavian vein catheterization, D-dimer, and bedridden duration after injury among patients between two groups (with χ(2) values from 4.569 to 11.324, Z values respectively 7.357 and 7.012, P<0.05 or P<0.01). (3) Age, total burn area, burn in lower limbs, infection of wound, and D-dimer were the independent risk factors of DVT (with odds ratio respectively 2.904, 2.655, 3.574, 2.786, 3.142, 95% confidence interval respectively 1.504-7.652, 1.368-6.594, 1.958-8.511, 1.459-7.001, 1.922-8.062, P values below 0.05).

CONCLUSIONS

The incidence of DVT in burn patients is relatively low; it is diagnosed after the 20th day post injury in most patients, and the overwhelming majority is the peripheral type. Age, total burn area, burn in lower limbs, infection of wound, and D-dimer are the independent risk factors of DVT in burn patients, with which its occurrence could be predicted.

A novel protocol allowing oral delivery of a protein complement inhibitor that subsequently targets to inflamed colon mucosa and ameliorates murine colitis

While there is evidence of a pathogenic role for complement in inflammatory bowel disease, there is also evidence for a protective role that relates to host defence and protection from endotoxaemia. There is thus concern regarding the use of systemic complement inhibition as a therapeutic strategy. Local delivery of a complement inhibitor to the colon by oral administration would ameliorate such concerns, but while formulations exist for oral delivery of low molecular weight drugs to the colon, they have not been used successfully for oral delivery of proteins. We describe a novel pellet formulation consisting of cross-linked dextran coated with an acrylic co-polymer that protects the complement inhibitor CR2-Crry from destruction in the gastrointestinal tract. CR2-Crry containing pellets administered by gavage, were characterized using a therapeutic protocol in a mouse model of dextran sulphate sodium (DSS)-induced colitis. Oral treatment of established colitis over a 5-day period significantly reduced mucosal inflammation and injury, with similar therapeutic benefit whether or not the proton pump inhibitor, omeprazole, was co-administered. Reduction in injury was associated with the targeting of CR2-Crry to the mucosal surface and reduced local complement activation. Treatment had no effect on systemic complement activity. This novel method for oral delivery of a targeted protein complement inhibitor will reduce systemic effects, thereby decreasing the risk of opportunistic infection, as well as lowering the required dose and treatment cost and improving patient compliance. Furthermore, the novel delivery system described here may provide similar benefits for administration of other protein-based drugs, such as anti-tumour necrosis factor-α antibodies.

Dispersion and fate of ⁹⁰Sr in the Northwestern Pacific and adjacent seas: global fallout and the Fukushima Dai-ichi accident

The 3D compartment model POSEIDON-R was applied to the Northwestern Pacific and adjacent seas to simulate the transport and fate of (90)Sr in the period 1945-2010 and to perform a radiological assessment on the releases of (90)Sr due to the Fukushima Dai-ichi nuclear accident for the period 2011-2040. The contamination due to runoff of (90)Sr from terrestrial surfaces was taken into account using a generic predictive model. A dynamical food-chain model describes the transfer of (90)Sr to phytoplankton, zooplankton, molluscs, crustaceans, piscivorous and non-piscivorous fishes. Results of the simulations were compared with observation data on (90)Sr for the period 1955-2010 and the budget of (90)Sr activity was estimated. It was found that in the East China Sea and Yellow Sea the riverine influx was 1.5% of the ocean influx and it was important only locally. Calculated concentrations of (90)Sr in water, bottom sediment and marine organisms before and after the Fukushima Dai-ichi accident are in good agreement with available experimental measurements. The concentration of (90)Sr in seawater would return to the background levels within one year after leakages were stopped. The model predicts that the concentration of (90)Sr in fish after the Fukushima Dai-ichi accident shall return to the background concentrations only 2 years later due to the delay of the transfer throughout the food web and specific accumulation of (90)Sr. The contribution of (90)Sr to the maximal dose rate due to the FDNPP accident was three orders of magnitude less than that due to (137)Cs, and thus well below the maximum effective dose limits for the public.

Preperitoneal femoral hernioplasty: an "umbrella" technique

INTRODUCTION

Tension-free inguinal mesh-plug hernioplasty is well established. However, femoral hernia repair remains challenging and controversial. We aimed to evaluate a preperitoneal approach of tension-free hernioplasty for femoral hernia upon the anatomy rationality.

METHODS

A prospective study of 62 patients between October 1999 and June 2011 received femoral hernioplasty in our hospital. This repair method involved a preperitoneal approach accomplished under regional or local anesthesia with mesh and plug; the emphasis was put on fulfilling the abdominal defect, i.e., the myopectineal orifice, with the plug flattened like an "umbrella", above the femoral ring but not to fill the femoral ring.

RESULTS

All cases receiving preperitoneal tension-free hernioplasty had a smooth recovery. There were no severe complications, and no recurrences were detected within a 0.5- to 4-year follow-up. No specific restrictions with regard to activity were placed on the patients after surgery. All cases were able to return to normal life, including work, within 2 weeks.

CONCLUSIONS

The preperitoneal tension-free hernioplasty may be a more effective method of femoral hernia repair; meanwhile, we must re-understand the anatomy of femoral hernia correctly so as to restore the anatomic and physiologic functions at this region optimally.

Regional long-term model of radioactivity dispersion and fate in the Northwestern Pacific and adjacent seas: application to the Fukushima Dai-ichi accident

The compartment model POSEIDON-R was modified and applied to the Northwestern Pacific and adjacent seas to simulate the transport and fate of radioactivity in the period 1945-2010, and to perform a radiological assessment on the releases of radioactivity due to the Fukushima Dai-ichi accident for the period 2011-2040. The model predicts the dispersion of radioactivity in the water column and in sediments, the transfer of radionuclides throughout the marine food web, and subsequent doses to humans due to the consumption of marine products. A generic predictive dynamic food-chain model is used instead of the biological concentration factor (BCF) approach. The radionuclide uptake model for fish has as a central feature the accumulation of radionuclides in the target tissue. The three layer structure of the water column makes it possible to describe the vertical structure of radioactivity in deep waters. In total 175 compartments cover the Northwestern Pacific, the East China and Yellow Seas and the East/Japan Sea. The model was validated from (137)Cs data for the period 1945-2010. Calculated concentrations of (137)Cs in water, bottom sediments and marine organisms in the coastal compartment, before and after the accident, are in close agreement with measurements from the Japanese agencies. The agreement for water is achieved when an additional continuous flux of 3.6 TBq y(-1) is used for underground leakage of contaminated water from the Fukushima Dai-ichi NPP, during the three years following the accident. The dynamic food web model predicts that due to the delay of the transfer throughout the food web, the concentration of (137)Cs for piscivorous fishes returns to background level only in 2016. For the year 2011, the calculated individual dose rate for Fukushima Prefecture due to consumption of fishery products is 3.6 μSv y(-1). Following the Fukushima Dai-ichi accident the collective dose due to ingestion of marine products for Japan increased in 2011 by a factor of 6 in comparison with 2010.

Abstract P4-07-11: Dual characteristics of microRNA-484 modulated cytidine deaminase (CDA) axis in breast cancer: Chemo-resistance and regulating cell proliferation

Acquired resistance to chemotherapy is a major clinical obstacle to achieve successful treatment in breast cancer. Cancer cells could evolve a complicated sensory network to develop resistance to chemo treatment. Recently, microRNAs modulated chemo-resistance is investigated as a new paradigm in cancer biology and some acquired mis-expression of miRs confer cancer cells to escape chemotherapy. However, it is important to address whether these miRs also play various intrinsic roles in carcinogenesis. Here, our study demonstrated that miR-484 could modulate cytidine deaminase (CDA) axis, playing various roles in chemo-resistance and cell proliferation.

We have generated a chemo-resistant breast cancer cell line (MDA-MB-231 Gem) which has 10 fold higher IC50 value than MDA-MB-231 cells in response to gemcitabine (dFdC) treatment through molecular evolution. Gene ontology analysis showed that cytidine degradation pathway was activated in the resistant cells, and qPCR array confirmed that cytidine deaminase (CDA), which converts dFdC to dFdU, was significantly upregulated. Interestingly, microRNA array analysis implicated that miR-484, which might target the 3’UTR region of CDA gene was down-regulated in these resistant cells. Furthermore, 3’UTR luciferase reporter assay and western blot revealed that miR-484 directly regulates CDA gene expression. Over-expression of miR-484 can sensibilize the resistant cells to dFdC treatment. Remarkably, restoration of CDA gene strongly converts miR-484–mediated dFdC sensibilization. These results implicated that miR-484/CDA axis play a pivotal role in chemo-resistance. Unexpectedly, further studies implicated that miR-484/CDA axis could also regulate cell proliferation due to disrupting cell cycle. We found that the chemo-resistant cells had deficiency in cell cycle progression at the S-phase transition, and miR-484 could significantly promote cell growth and overcome cell cycle arrest with CDA down-regulation. Moreover, reintroduction of CDA gene could abrogate miR-484-induced effects on cell proliferation via reactivating S-phase checkpoint. Importantly, the Kaplan-Meier survival analysis supported that higher expression of CDA in breast cancer patients indicates better outcome in DFS model.

In summary, this study uncovers for a previously unknown axis that cytidine deaminase was a direct downstream target for miR-484. The miR484/CDA axis could modulate cells into stagnant status for promoting cellular resistance to DNA damage agents in chemotherapy. On the other hand, as CDA gene participates in cell cycle S-phase arrest, miR484/CDA axis could also contribute to cell proliferation. Taken together, our findings provided new evidences that miR-484/CDA axis has various functions in cell proliferation and chemo-resistance and might be considered as a candidate therapeutic target in breast cancer.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-07-11.

Clonal diversity of Acinetobacter baumannii clinical isolates revealed by a snapshot study

Background

Acinetobacter baumannii is a notorious opportunistic pathogen mainly associated with hospital-acquired infections. Studies on the clonal relatedness of isolates could lay the foundation for effective infection control. A snapshot study was performed to investigate the clonal relatedness of A. baumannii clinical isolates in our local settings.

Results

Among 82 non-repetitive Acinetobacter spp. clinical isolates that were recovered during a period of four days in 13 hospitals in Sichuan, Southwest China, 67 isolates were identified as A. baumannii. Half of the 67 A. baumannii isolates were non-susceptible to carbapenems. bla_OXA-23 was the only acquired carbapenemase gene detected, present in 40 isolates including five carbapenem-susceptible ones. The isolates belonged to 62 pulsotypes determined by PFGE and 31 sequence types (ST) by multi-locus sequence typing. Forty-three isolates belonged to the globally-disseminated clonal complex 92, among which ST75, ST92 and ST208 were the most common sequence types.

Conclusions

Clinical isolates of A. baumannii were diverse in clonality in this snapshot study. However, most of the isolates belonged to the globally-distributed clonal complex CC92. ST75, ST92 and ST208 were the most common types in our region. In particular, ST208 might be an emerging lineage carrying bla_OXA-23.