Objective To investigate the risk factors of prognosis of gram-positive bacteria associated nosocomial bloodstream infections,and to investigate the drug resistance of the strains.Methods A total of 132 patients with gram-positive bacteria associated nosocomial bloodstream infections were collected from the First Affiliated Hospital of Zhejiang Chinese Medicine University during January 2010 and December 2012.Clinical data including demographic characteristics,underlying diseases,risk factors and use of antibacterial agents were retrospectively analyzed.According to 28-day prognosis,patients were divided into survival group (n =97) and death group (n =35).Binary logistic regression was used to identify the risk factors of 28-day fatality.Results Among 132 patients,49 (37.12％) were infected with coagulase-negative Staphylococcus,46 (34.85％) were infected with Staphylococcus aureus,37 (28.03％)were infected with Enterococcus.The rates of methicillin resistant coagulase negative Staphylococci (MRCNS) and methicillin-resistant Staphylococcus aureus (MRSA) were 77.55％ (38/49) and 54.35％ (25/46),respectively.The rate of linezolid resistant coagulase negative Staphylococci was 8.16％ (4/49) ; Four out of 37 strains (10.81％) of Enterococcus were both resistant to vancomycin and linezolid.Binary logistic regression showed that septic shock (OR =34.344,95％ CI:6.539-180.389,P =0.000),deep venous catheterization (OR =13.411,95％ CI:1.877-95.832,P =0.010),no catheter removal after infection (OR =8.759,95％ CI:2.197-34.911,P =0.002),parenteral nutrition (OR =3.684,95％ CI:1.072-12.663,P =0.038),inappropriate antibacterial therapy in early stage (OR =12.951,95％ CI:2.075-80.836,P =0.006) and Enterococcus associated bloodstream infections (OR =4.227,95％ CI:1.090-16.394,P =0.037) were independent risk factors of 28-day fatality in patients with gram-positive bacteria associated nosocomial bloodstream infections.Conclusions The predominant pathogens are coagulase-negative Staphylococcus,Staphylococcus aureus and Enterococcus in gram-positive bacteria associated nosocomial bloodstream infections.Patients with septic shock,deep venous catheterization,no catheter removal after infection,parenteral nutrition,inappropriate antibacterial therapy in early stage and Enterococcus associated bloodstream infections are likely to have high fatality rate.

OBJECTIVETo determine the physicochemical properties of the mutanase of Trichoderma harzianum isolated from China and to study the influence of mutanase on the adherence of oral Streptococci and the structure of oral biofilms.

METHODSSix fungal strains belonging to Trichoderma were tested for mutanase production in the same cultural condition, the strain producing the highest mutanase activity was studied further and the pH and temperature optimum of the enzyme was determined. The RT-PCR method was used to obtain the gene coding for mutanase and the product was cloned to pMD18-T simple vector for sequencing. Inhibition effects of mutanase on the adherence of Streptococcus sobrinus OMZ176, Streptococcus sobrinus 6715, Streptococcus mutans MT8148 were studied by adherence test. The optical sectioning of biofilms with or without mutanase supplementation were analyzed by confocal laser scanning microscopy (CLSM).

RESULTSThe highest enzymatic activity was achieved by Trichoderma harzianum Th1, the maximum activity was at pH 5.5 and at 40 degrees C. The nucleotide sequence was 92% homology with that of a known gene coding a mutanase (GenBank accession No. AJ243799). The adherence of Streptococcus sobrinus OMZ176, Streptococcus sobrinus 6715, Streptococcus mutans MT8148 was significantly inhibited by mutanase. Compared with control, the biofilms with mutanase supplementation had lower height and sparser structure.

CONCLUSIONSThe mutanase from Trichoderma harzianum Th1 can inhibit the adherence of oral Streptococci and had an influence on the structure of oral biofilms.

Bacterial Adhesion ; drug effects ; Biofilms ; Glycoside Hydrolases ; chemistry ; physiology ; Streptococcus mutans ; drug effects ; Streptococcus sobrinus ; drug effects ; Trichoderma ; enzymology ; pathogenicity

Hyperglycemia is an important initiator of cardiovascular disease, contributing to the development of cardiomyocyte death and diabetic complications. The purpose of the present study was to investigate whether high glucose state could induce apoptosis of rat cardiomyocyte cell line H9c2 through microRNA-mediated Bcl-2 signaling pathway. The expression of miR-34a and Bcl-2 mRNA was detected by using real-time PCR. Western blotting was used to examine the changes in apoptosis-associated protein Bcl-2. Apoptosis of H9c2 cells was tested by using flow cytometry. The results showed that the expression of miR-34a was significantly elevated and that of Bcl-2 was strongly reduced, and apoptosis of cardiomyocytes was apparently increased in the high-glucose-treated H9c2 cells as compared with normal-glucose-treated controls. In addition, we identified Bcl-2 gene was the target of miR-34a. miR-34a mimics reduced the expression of Bcl-2 and increased glucose-induced apoptosis, but miR-34a inhibitor acted as the opposite mediator. Our data demonstrate that miR-34a contributes to high glucose-induced decreases in Bcl-2 expression and subsequent cardiomyocyte apoptosis.
Animals ; Apoptosis ; Cell Line ; Glucose ; metabolism ; MicroRNAs ; genetics ; metabolism ; Myocytes, Cardiac ; metabolism ; Rats

Objective To explore the clinical characteristics and prognostic factors of elderly patients with commu-nity-acquired bloodstream infection(CA-BSI),and provide basis for clinical treatment and prevention.Methods Medical records of elderly patients diagnosed with CA-BSI in a tertiary first-class hospital of Changsha from 2017 to 2021 were collected.Patients were divided into a survival group and a death group according to the prognosis after 30 days hospitalization.The differences in clinical data between two groups of patients were compared,and influen-cing factors for the prognosis in CA-BSI patients were analyzed.Results A total of 575 elderly CA-BSI patients were included in the analysis,with 535 cases in the survival group and 40 cases in the death group.Univariate ana-lysis results suggested that death of elderly CA-BSI patients was related to gender,age,history of hemodialysis,glucocorticoid usage,indwelling catheter,concomitant heart disease,albumin,creatinine,and sequential organ fai-lure assessment(SOFA)score(all P＜0.05).Multivariate logistic regression analysis results suggested that old age(OR=1.062,95％CI:1.016-1.109),high SOFA score(OR=1.161,95％CI:1.067-1.262),glucocorti-coid usage(OR=6.006,95％CI:2.441-14.774)were independent risk factors for the death of elderly CA-BSI patients,while normal albumin(OR=0.942,95％CI:0.891-0.995)was a protective factor.Conclusion Elderly CA-BSI patients have high risks of death.It is necessary to improve the immunity of patients as well as use antimi-crobial agents and glucocorticoids rationally,so as to reduce the risk of death in patients.

Objective To investigate the effect of paeoniflorin ( PF) on cytochrome P450 2E1( CYP450 2E1) and lipid peroxidation in L02 cell induced by ethanol.Methods L02 cell model was established by 75 mmol · L-1 ethanol.After treated with paeoniflorin, superoxide dismutase ( SOD) and malondialdehyde ( MDA) levels in the cell culture supernatant were detected by biochemical analysis.The expressions of CYP450 2E1 in L02 cell were observed by RT-PCR and immunocyto-chemistry.Results Compared with the control group, serum SOD levels in model group were significantly decreased, while MDA levels were elevated ( P <0.05 ).The levels of CYP450 2E1 mRNA and protein were significantly increased in model group (P<0.05).However, com-pared with the model group, SOD levels in the cell culture supernatant of PF group were much higher, while MDA levels were decreased, and the levels of CYP450 2E1 mRNA and protein were significantly decreased in PF group ( P<0.05 ).Conclusion The effect of PF on the improve-ment of L02 cell damaged by ethanol and reducing lipid peroxidation could be related with the regulation on the expression of CYP450 2 E1.

Objective To investigate the pharmacokinetics of mycophe-nolate mofetil ( MMF) in Chinese adult patients with autoimmune disea-ses.Methods Fourteen patients with autoimmune disease were included in this study.Oral dose ( MMF 0.75 g, q12 h) was given for the first time and 7 days later steady -state.Serum concentrations of the myco-phenolic acid ( MPA) , an active metabolite of the pro -drug MMF, and its phenol glucuronide metabolite ( MPAG ) were determined by HPLC method.Pharmacokinetic parameters of MPA and MPAG were calculated and influences of renal function on MPA drug exposure and MPAG drug exposure in steady -state were investigated.Results The main pharma-cokinetic parameters of MPA after first -dose and steady -state were as follows: Cmax were ( 8.45 ±7.54 ) , ( 10.89 ±4.37 ) mg · L-1 , AUC0-12 h were (41.07 ±49.26 ), (55.09 ±41.74 ) mg· h· L-1 and the main pharmacokinetic parameters of MPAG after first -dose and steady-state were as follows: Cmax were (41.24 ±28.57 ), (67.63 ± 36.98) mg · L-1, AUC0-12h were (487.25 ±326.53 ), (720.79 ± 413.86 ) mg· h· L-1.A large variability existed in pharmacokinetic parameters of MPA and MPAG.The differences in pharmacokinetic parameters are larger between individual patient of the two groups , the AUC0-12h of steady -state compared with the first administration were both obviously greater ( P<0.05 ).There was an obviously inverse relation-ship between MPAG drug exposure and renal function ( P<0.05 ) , however , MPA drug exposure was less affected by renal function ( P>0.05 ).Conclusion In patients with autoimmune disease receiving a fixed MMF dose , there is a large inter-individual variability of MMF pharmacokinetics and accumulation of MPA and MPAG drug exposure .In addition, a significant accumulated phenomenon was found.

OBJECTIVETo evaluate the diagnostic efficacy of real?time polymerase chain reaction (q?PCR) for Clostridium difficile infection (CDI) in comparison with routine culture and enzyme?linked fluorescent spectroscopy?based aprroaches.

METHODSStool samples were collected from suspected CDI cases in General Hospital of Guangzhou Military Command of PLA between May and December in 2016. All the samples were examined with 3 methods, namely enzyme?linked fluorescent spectroscopy for detecting Clostridium difficile toxin A/B (CDAB), detection of glutamate dehydrogenase (GDH), and q?PCR for amplification of Clostridium difficile?specific gene tpi and toxin gene (tcdA/tcdB), with the results of fecal culture as the reference for evaluating the diagnostic efficacy of the 3 methods.

RESULTSOf the total of 70 fecal samples, 13 (18.57%) were found to be positive for Clostridium difficile, including toxin?producing strains in 6 (8.57%) samples. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic coincidence rate of q?PCR for tpi were 92.31%, 91.23%, 70.59%, 98.11% and 91.43%, respectively, which were significantly higher than those of GDH test (84.62%, 84.21%, 55.00%, 96.00%, and 84.29%, respectively; Χ=24.881, P<0.001). The sensitivity of q?PCR for tcdA/cdB was significantly higher than that of enzyme?linked fluorescent spectroscopy for CDAB in detecting CDI (66.67% vs 33.33%; Χ=35.918, P<0.001).

CONCLUSIONBoth CDAB detection and q?PCR have a high specificity in detecting CDI, but GDH detection has a good sensitivity, and all these 3 methods have a high negative predictive value. Compared with other detection methods, amplification of tpi and tcdA/tcdB using q?PCR allows more rapid, sensitive and specific detection of CDI.

ation were complicated, with the characteristics as the obvious decreasing number of patients, with no food-borne isolates in 2007.

Objective: To analyze the short-term efficacy of sleeve gastrectomy plus uncut jejunojejunostomy (SG+uncut JJB) for patients with obesity. Methods: This prospective study was conducted in the General Surgery Department of Beijing Chaoyang Hospital from January to December 2020 (NCT04534504). The inclusion criteria were patients with a body mass index (BMI) of >32.5 kg/m², type 2 diabetes mellitus (T2DM) or at least two comorbidities with a BMI of 27.5-32.5 kg/m², a waist circumference of >90 cm (male) or >85 cm (female), and those aged between 16 and 65 years. The exclusion criteria included patients who were pregnant, diagnosed with severe neurological or mental illnesses, long-term users of antidepressants and immunosuppressants, and diagnosed with severe gastroesophageal reflux disease or underwent revision surgery. Patients with incomplete follow-up data or insufficient follow-up time were also excluded. Patients were divided into SG-uncut JJB group and SG group according to doctor's recommendation and patients' wills. The primary endpoint was the percentage of excess weight loss (%EWL), and the secondary endpoints were the percentage of total weight loss (%TWL) and the T2DM remission rate. All patients were regularly followed up until the end of December 2020. Results: After excluding seven patients who did not meet the inclusion criteria, 47 eligible patients were finally identified, with 21 in the SG+uncut JJB group and 26 in the SG group. The operation time (140 [110-180] minutes vs. 90 [70-180] minutes, Z=-3.642, P=0.001) and total cost ([54,000 ± 6000] yuan vs. [49,000 ± 7000] yuan, t=2.590, P=0.013) were slightly higher in the SG+uncut JJB group than in the SG group (all P<0.05). However, no significant differences were observed in terms of postoperative hospital stay, operative blood loss, and postoperative complications between the two groups (all P>0.05). The incidence of nausea and vomiting was significantly lower in the SG+uncut JJB group than in the SG group (9.5% [2/21] vs. 46.2% [12/26], χ²=7.453, P=0.006}. The %EWL and %TWL in the SG+uncut JJB group tended to increase gradually with time. The same trend was also observed in the SG group during the first 6 months of follow-up. The 12-month %EWL and %TWL in the SG group were slightly lower compared with the 6-month %EWL and %TWL (P=0.001). The 12-month %EWL values in the SG+uncut JJB and SG groups were (72.4%±12.3%) and (63.6%±25.7%), respectively. However, no significant differences were observed between the two groups in terms of %EWL. Moreover, the 1-month ([11.1%±2.4%] vs. [8.2%±4.4%], P=0.011) and 12-month %TWL ([29.7%±6.9%] vs. [20.3%±7.2%], P=0.001) were significantly higher in the SG+uncut JJB group than in the SG group. No significant differences were observed in terms of T2DM and hypertension remission (all P>0.05). Conclusion: SG+uncut JJB might achieve a promising weight-loss effect similar to SG with a relatively lower incidence of postoperative nausea and vomiting, and it might be an effective and safe approach for obesity management.
Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; Diabetes Mellitus, Type 2/surgery* ; Gastrectomy ; Gastric Bypass ; Immunosuppressive Agents ; Laparoscopy ; Obesity/surgery* ; Obesity, Morbid/surgery* ; Prospective Studies ; Retrospective Studies ; Treatment Outcome ; Weight Loss

Objective: To compare the effects of 3 treatment strategies (emergent surgery, self-expanding metallic stents, self-expanding metallic stents plus neoadjuvant chemotherapy) on postoperative anal function and quality of life in patients with complete obstructive left hemicolon cancer. Methods: A retrospective cohort study was conducted. Clinical data of patients with complete obstructive left hemicolon cancer admitted to General Surgery Department of Beijing Chaoyang Hospital between January 2017 and October 2019 were retrospectively collected. Patient inclusion criteria: (1) complete obstructive left hemicolon cancer was confirmed through clinical manifestation and abdominal computed tomography; (2) adenocarcinoma was confirmed by postoperative pathology; (3) emergent radical resection of primary tumor was performed with temporary stoma, or radical resection of primary tumor and primary anastomosis was performed without stoma, 7 to 14 days after completion of insertion of self-expanding metallic stents. Patients who did not receive stoma reversion after emergent operation were excluded. According to different therapies, patients were divided into three groups: emergent surgery (ES) group, self-expanding metallic stents (SEMS) group and self-expanding metallic stents plus neoadjuvant chemotherapy (SEMS+NAC) group. Wexner score for incotinence (higher score indicates the worse anal function), Vaizey score (>10 indicates fecal incontinence) and low anterior resection syndrome (LARS) scale (higher score indicates the worse anal function) were applied to evaluate anal function of patients among groups at postoperative 1-, 6- and 12-month. EORTC QLQ-C30 questionnaire was used to assess the quality of life. Risk factors of decreased anal function were identified by logistic regression analysis. Results: A total of 72 patients were enrolled, including 27 (37.5%) patients in ES group, 23 (31.9%) in SEMS group and 22 (30.6%) in SEME+NAC group. The baseline characteristics including age, gender, tumor location, comorbidities, total blood loss, operation time and postoperative complications, were comparable among groups, except that the proportion of laparoscopic surgery was significantly lower in ES group (4/27, 14.9%) than that in SEMS (15/23, 65.2%) and SEMS+NAC group (16/22, 72.7%) with significant difference (P<0.001). The follow-up ended up to October 2020, and the overall follow-up rate was 79.2% (57/72). No significant differences existed in the Wexner score of patients among groups at postoperative 1-, 6- and 12-month (all P>0.05). The Vaizey scores at postoperative 1-month in ES, SEMS and SEMS+NAC group were 7 (0-17), 3 (0-7) and 4 (0-8) respectively with significant difference (H=18.415, P=0.001), and the scores in SEMS and SEMS+NAC groups were significantly lower than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC group (P>0.05). Vaizey scores at postoperative 6- and 12-month among 3 groups were not significantly different (both P>0.05). The LARS scores at postoperative 1-month in ES, SEMS and SEMS+NAC groups were 20 (0-37), 15 (0-24) and 16 (0-28) respectively with significant difference (H=3.660, P=0.036), and the scores in SEMS and SEMS+NAC groups were significantly lower than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC groups (P>0.05). LARS scores at postoperative 6- and 12-month among 3 groups were not significantly different (both P>0.05). The QLQ-C30 score revealed that the social function of patients in SEMS group and SEMS+NAC group was significantly better than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC group (P>0.05). The logistic regression analysis revealed that only ES was an independent risk factor of decreased anal function (OR=2.264, 95% CI: 1.098-4.667, P=0.027). Conclusion: Compared to ES, SEMS may improve quality of life and short-term anal function of patients with complete obstructive left hemicolon cancer.
Humans ; Intestinal Obstruction ; Postoperative Complications ; Quality of Life ; Rectal Neoplasms ; Retrospective Studies ; Syndrome ; Treatment Outcome