INTRODUCTION: Patient-centred medical care has been rising in importance since the turn of the century. It entails treating patients in relation to their biopsychosocial outlook so as to support the management of their conditions. The extent to which a patient is enabled to acquire skills and knowledge can be measured with the Patient Enablement Instrument (PEI) proposed by Howie and colleagues, and it has been noted to be more reflective of a good consultation compared to patient satisfaction scores. This study aimed to determine the level of patient enablement in the Singaporean context and the factors facilitating it. METHODS: We conducted an embedded mixed method study with primary care patients in two phases: (a) a PEI questionnaire was completed by 150 patients; and (b) a qualitative approach using focused group discussions and individual interviews was used to explore factors associated with high enablement. RESULTS: The mean PEI score was 4.5 ± 4.4, with significantly higher scores among patients attending specialised primary care clinics. Important physician factors were doctors' advice, attitude and relationship with the patient. Critical system factors included good continuity of care, workload and financial support, while patient factors included their beliefs, preparedness, inquisitiveness and trust, with considerable impact from the influence of community. CONCLUSION The PEI score in the Singaporean context is similar to that of other Asian contexts, but slightly higher than that reported in Western studies. Good doctor-patient relationships, efficient systems facilitating continuity of care, and motivated and informed patients all contribute to increased enablement.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndromecoronavirus-2 (SARS-CoV-2), has spread over the world causing a pandemic which is still ongoing since its emergence in late 2019. A great amount of effort has been devoted to understanding the pathogenesis of COVID-19 with the hope of developing better therapeutic strategies. Transcriptome analysis using technologies such as RNA sequencing became a commonly used approach in study of host immune responses to SARS-CoV-2. Although substantial amount of information can be gathered from transcriptome analysis, different analysis tools used in these studies may lead to conclusions that differ dramatically from each other. Here, we re-analyzed four RNA-sequencing datasets of COVID-19 samples including human bronchoalveolar lavage fluid, nasopharyngeal swabs, lung biopsy and hACE2 transgenic mice using the same standardized method. The results showed that common features of COVID-19 include upregulation of chemokines including CCL2, CXCL1, and CXCL10, inflammatory cytokine IL-1β and alarmin S100A8/S100A9, which are associated with dysregulated innate immunity marked by abundant neutrophil and mast cell accumulation. Downregulation of chemokine receptor genes that are associated with impaired adaptive immunity such as lymphopenia is another common feather of COVID-19 observed. In addition, a few interferon-stimulated genes but no type I IFN genes were identified to be enriched in COVID-19 samples compared to their respective control in these datasets. These features are in line with results from single-cell RNA sequencing studies in the field. Therefore, our re-analysis of the RNA-seq datasets revealed common features of dysregulated immune responses to SARS-CoV-2 and shed light to the pathogenesis of COVID-19.

Objective:To measure the kinetic parameters of murine plasma albumin synthesis by deuterated water (2H2O).Methods:Twenty SD rats received 2H2O-labelled intraperitoneal injection and drinking.At the end of the 1st,3rd,5th,6th,10th week,every 4 rats was respectively sacrificed by cardiac puncture for blood collection.Plasma albumin was purified by trichloroacetic acid and ethanol,identified by SDS-PAGE and hydrolyzed by hydrochloric acid.The alanine in albumin and plasma was separated,purified and derived.The deuterium enrichments of alanyl unit in albumin and alanine in plasma were determined by GC-MS.The fractional synthesis rate of albumin and synthetic dynamic equation were calculated.Results:The fractional synthesis rate of plasma albumin was 15.3％/w,and synthetic dynamic equation was ft =1.256 × (1-e-0.153t).Conclusion:The kinetic parameters of plasma albumin synthesis can be measured by 2H2O labeling method,which can be applied in the study of physiological and pathological metabolic mechanism.

BACKGROUNDThe expression of therapeutic gene and its anti-tumor effects will be augmented and a synergism of oncolytic virus with the therapeutic gene is speculated. This study was undertaken to assess the anti-tumor effects of a novel gene-viral therapeutic system CNHK300-mEndostatin (CNHK300-mE) in hepatocellular carcinoma (HCC).

METHODSA novel gene-viral therapeutic system named CNHK300-mE was constructed using the human telomerase reverse transcriptase (hTERT) promoter to drive the expression of the adenovirus E1A gene and cloning the therapeutic gene mouse endostatin into the adenovirus genome. By the tissue culture infectious dose 50 (TCID50) method and cytoviability assay, the replicative and cytolytic capabilities of CNHK300-mE in two HCC lines (HepGII and Hep3B) and one normal cell line (MRC-5) were analyzed, and the transgene expressions of mouse endostatin in vitro and in vivo were detected by Western blotting and ELISA assay. Tumor growth suppression and anti-angiogenesis effects in vivo were investigated using nude mice xenografts model derived from SMMC-7721 HCC cells.

RESULTSThe 3296-fold replicating capacity of CNHK300-mE in HCC cell lines versus in the normal cell line at 96 hours post infection and the 25-fold effective dose for killing 50% cells (ED50) in the normal cell line versus HCC cell lines, which were both superior to ONYX-015, were observed. Tumor growth suppression of CNHK300-mE superior to either Ad-mE or ONYX-015 was demonstrated (P < 0.01) and the anti-angiogenic effects in vivo superior to Ad-mE were also observed with immunohistochemical staining of von Willebrand factor. In comparison with non-replicative adenovirus Ad-mE, the transgene expression of mE mediated by CNHK300-mE was significantly higher in vitro (P < 0.005) and in vivo (P < 0.05).

CONCLUSIONBeing capable of replicating in and lysing the telomerase-positive HCC cells and mediating effective expression of the therapeutic gene in vitro and in vivo, the novel gene-viral therapeutic system CNHK300-mE is potentially effective in the treatment of HCC.

Adenoviridae ; genetics ; Adenovirus E1A Proteins ; genetics ; Animals ; Blotting, Western ; Enzyme-Linked Immunosorbent Assay ; Genetic Therapy ; Humans ; Liver Neoplasms, Experimental ; therapy ; Mice ; Mice, Inbred BALB C ; Neoplasm Transplantation ; Transplantation, Heterologous ; Virus Replication

Objective To study the general condition and changes of red blood cell transfusion in Peking Union Medical College Hospital in the years of 2010 and 2013.Methods Random sampling was conducted among the in-patients who received red blood cell transfusion during hospitalization at Peking Union Medical Col-lege Hospital in 2010 and 2013.The clinical information including gender, age, wards where transfusion was performed, and the hemoglobin values before the first red blood cell transfusion were compared between the 2 years.Results Totally, 174 cases in 2010 and 500 cases in 2013 were enrolled.The mean hemoglobin value before red blood cell transfusion in non-surgical and surgical wards were ( 67.71 ±11.31 ) g/L and ( 78.68 ± 15.64) g/L respectively in 2010, which were (63.75 ±12.41) g/L and (81.53 ±17.09) g/L respectively in 2013.Hemoglobin detection rates in in-patients before red blood cell transfusion in non-surgical wards in 2010 and 2013 were both 100%;in surgical wards, the hemoglobin detection rate was 68.6%in 2013, significantly higher than that in 2010 (47.7%, P<0.001) .Conclusions In both non-surgical and surgical wards of Pe-king Union Medical College Hospital, the hemoglobin threshold for initiating red blood cell transfusion were in accordance with the recommendations of international and China guidelines, indicating that in our hospital, in-dication of red blood cell transfusion is strictly followed and transfusion administration is rational with continuous improvement.

Objective To investigate the clinical characteristics of patients with hemoglobin level higher than the recommended threshold by guidelines before receiving red blood cell( RBC )transfusion in non-surgical departments of Peking Union Medical College Hospital( PUMCH). Methods One thousand patients were random-ly selected from hospitalized patients who received RBC transfusion at PUMCH between January and December in 2013. Among them,those in non-surgical departments and with hemoglobin≥70 g/L before transfusion were iden-tified,and their hemoglobin level before RBC transfusion,proportion in non-surgical patients receiving RBC trans-fusion,symptoms and signs related to anemia before transfusion were described. Results Of the 1000 patients, 270 were from non-surgical departments,and their average hemoglobin before RBC transfusion was( 63. 7 ± 11. 5) g/L. Seventy-four of the 270(27. 4%)patients had hemoglobin ≥70 g/L before RBC transfusion,inclu-ding 60(22. 2%)patients with homoglobin≥70 g/L and ﹤80 g/L,10(3. 7%)patients with homoglobin≥80 g/L and ﹤90 g/L,and 4(1. 5%)patients with hemoglobin≥90 g/L. Among the 74 patients,symptoms and signs related to anemia and decision-making of the transfusion were identified in 59 ( 79. 7%)patients’ medical records,the other 15 ( 20. 3%)patients with missing data were those with more severe conditions, multiple co-morbidities,multi-organ involvement,unstable conditions,or poor tolerance to decreasing hemoglo-bin level. Conclusions The hemoglobin threshold for RBC transfusion in non-surgical departments of PUMCH was consistent with the recommendations of both international and Chinese guidelines. Given specific conditions, RBC transfusion in those patients with hemoglobin level higher than the recommended threshold is clinically ap-propriate,but the decision-making process regrading RBC transfusion should be recorded in detail.

The aim of the present study was to measure the kinetic parameters of skeletal muscle protein synthesis in rats by deuterated water (HO). Twenty Sprague-Dawley (SD) rats were labeled byHO through intraperitoneal injection and drinking. At the each end of the 1st, 3rd, 5th, 6th and 10th week after the firstHO labeling, four rats were sacrificed by cardiac puncture for blood plasma and quadriceps femoris sampling. Skeletal muscle protein and free amino acids in plasma were purified, hydrolyzed by hydrochloric acid and derived. The deuterium enrichments ofH-labeled alanyl in skeletal muscle protein and plasma protein-boundH-labeled alanine were determined by gas chromatography-mass spectrometry (GC-MS). The fractional synthesis rate of skeletal muscle protein and synthetic dynamic equation were calculated. The fractional synthetic rate of skeletal muscle protein was 12.8%/week, and synthetic dynamic equation was f= 0.158 × (1 - e). The results suggest that the kinetic parameters of skeletal muscle protein synthesis can be measured byHO labeling, and the method can be applied in long-term labeling experiment.
Alanine ; Amino Acids ; blood ; Animals ; Deuterium ; Gas Chromatography-Mass Spectrometry ; Kinetics ; Male ; Muscle Proteins ; biosynthesis ; Muscle, Skeletal ; metabolism ; Protein Biosynthesis ; Rats ; Rats, Sprague-Dawley ; Water

OBJECTIVE: To investigate the current status of antibiotic use for very and extremely low birth weight (VLBW/ELBW) infants in neonatal intensive care units (NICUs) of Hunan Province. METHODS: The use of antibiotics was investigated in multiple level 3 NICUs of Hunan Province for VLBW and ELBW infants born between January, 2017 and December, 2017. RESULTS: The clinical data of 1 442 VLBW/ELBW infants were collected from 24 NICUs in 2017. The median antibiotic use duration was 17 days (range: 0-86 days), accounting for 53.0% of the total length of hospital stay. The highest duration of antibiotic use was up to 91.4% of the total length of hospital stay, with the lowest at 14.6%. In 16 out of 24 NICUs, the antibiotic use duration was accounted for more than 50.0% of the hospitalization days. There were 113 cases with positive bacterial culture grown in blood or cerebrospinal fluid, making the positive rate of overall bacterial culture as 7.84%. The positive rate of bacterial culture in different NICUs was significantly different from 0% to 14.9%. The common isolated bacterial pathogens Klebsiella pneumoniae was 29 cases (25.7%); Escherichia coli 12 cases (10.6%); Staphylococcus aureus 3 cases (2.7%). The most commonly used antibiotics were third-generation of cephalosporins, accounting for 41.00% of the total antibiotics, followed by penicillins, accounting for 32.10%, and followed by carbapenems, accounting for 13.15%. The proportion of antibiotic use time was negatively correlated with birth weight Z-score and the change in weight Z-score between birth and hospital discharge (r=-0.095, -0.151 respectively, P<0.01), positively correlated with death/withdrawal of care (r=0.196, P<0.01). CONCLUSIONS Antibiotics used for VLBW/ELBW infants in NICUs of Hunan Province are obviously prolonged in many NICUs. The proportion of routine use of third-generation of cephalosporins and carbapenems antibiotics is high among the NICUs.
Anti-Bacterial Agents ; Birth Weight ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Intensive Care Units, Neonatal ; Surveys and Questionnaires

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.