OBJECTIVE To analyze the comprehensive intervention measures to raise the etiological submission rate for hospitalized patients before antimicrobial treatment and evaluate the effect.METHODS The hospitalized pa-tients who were treated with therapeutic antibiotics in the Affiliated Hospital of Inner Mongolia Medical University from Jan.2023 to Jun.2023 were assigned as the exploratory analysis phase,the hospitalized patients who were treated with therapeutic antibiotics from Jul.2023 to Dec.2023 were assigned as the first post-intervention phase,and the hospitalized patients who were treated with therapeutic antibiotics from Jan.2024 to Mar.2024 were as-signed as the second post-intervention phase.The related indexes for etiological submission rate before the antimi-crobial treatment were compared before and after the intervention.RESULTS After the comprehensive interven-tion,the etiological submission rate of the entire hospital before the antimicrobial treatment was increased from 28.30％to 42.22％in the first post-intervention phase and 55.86％in the second post-intervention phase.The etio-logical submission rate with respect to diagnosis of hospital-associated infection was increased from 68.34％before the intervention to 85.85％in the first post-intervention phase and 94.58％in the second post-intervention phase.The incidence of hospital-associated infection showed a slight downward trend,dropping from 1.51％to 1.27％in the first post-intervention phase and 1.11％in the second post-intervention phase.The proportion of submission of sterile samples showed a slight upward trend,which was 26.13％before the intervention,29.57％in the first post-intervention phase,28.96％in the second post-intervention phase.There were significant differences in the a-bove indexes(P＜0.05).The etiological submission rate before the combined use of key drugs was increased from 84.71％to 85.95％in the first post-intervention phase and 88.33％in the second post-intervention phase,and there was no significant difference.CONCLUSIONS The etiological submission rate of the hospitalized patients be-fore the antimicrobial treatment is remarkably raised by taking the comprehensive intervention measures,but the etiological submission rate before the combined use of key drugs does not meet the standard,the proportion of submission of the sterile samples is not remarkably raised.It is necessary to continuously complete the intervention measures in the next phase.

OBJECTIVE To analyze the comprehensive intervention measures to raise the etiological submission rate for hospitalized patients before antimicrobial treatment and evaluate the effect.METHODS The hospitalized pa-tients who were treated with therapeutic antibiotics in the Affiliated Hospital of Inner Mongolia Medical University from Jan.2023 to Jun.2023 were assigned as the exploratory analysis phase,the hospitalized patients who were treated with therapeutic antibiotics from Jul.2023 to Dec.2023 were assigned as the first post-intervention phase,and the hospitalized patients who were treated with therapeutic antibiotics from Jan.2024 to Mar.2024 were as-signed as the second post-intervention phase.The related indexes for etiological submission rate before the antimi-crobial treatment were compared before and after the intervention.RESULTS After the comprehensive interven-tion,the etiological submission rate of the entire hospital before the antimicrobial treatment was increased from 28.30％to 42.22％in the first post-intervention phase and 55.86％in the second post-intervention phase.The etio-logical submission rate with respect to diagnosis of hospital-associated infection was increased from 68.34％before the intervention to 85.85％in the first post-intervention phase and 94.58％in the second post-intervention phase.The incidence of hospital-associated infection showed a slight downward trend,dropping from 1.51％to 1.27％in the first post-intervention phase and 1.11％in the second post-intervention phase.The proportion of submission of sterile samples showed a slight upward trend,which was 26.13％before the intervention,29.57％in the first post-intervention phase,28.96％in the second post-intervention phase.There were significant differences in the a-bove indexes(P＜0.05).The etiological submission rate before the combined use of key drugs was increased from 84.71％to 85.95％in the first post-intervention phase and 88.33％in the second post-intervention phase,and there was no significant difference.CONCLUSIONS The etiological submission rate of the hospitalized patients be-fore the antimicrobial treatment is remarkably raised by taking the comprehensive intervention measures,but the etiological submission rate before the combined use of key drugs does not meet the standard,the proportion of submission of the sterile samples is not remarkably raised.It is necessary to continuously complete the intervention measures in the next phase.

Objective To investigate the distribution and antimicrobial resistance of Enterobacter cloacae complex(ECC)isolated from a tertiary hospital in Shanghai.Methods Clinical ECC isolates were collected from 2018 to 2020.Antimicrobial susceptibility test was performed with broth microdilution and agar dilution methods.PCR was applied to detect five carbapenemase genes(blaKPC,blaNDM,blaIMP,blaVIM and blaOXA-48).Results A total of 222 ECC isolates were collected from 2018-2020,including 36 strains(16.2％)from general surgery department.The strains were mainly isolated from sputum(41.0％)and urine(20.3％).MIC results showed that the isolates were highly resistant to trimethoprim-sulfamethoxazole,the second-and third-generation cephalosporins,aztreonam and quinolones(31.1％-71.2％resistant),but low resistance rates to tigecycline,amikacin,mecillinam,and ceftazidime-avibactam(0.5％-9.0％resistant).About 9.5％and 10.4％of the strains were resistant to meropenem and imipenem,respectively.A total of 34 ECC strains were carbapenem-nonsusceptible strains,of which 23 strains were resistant to carbapenems.Among the 34 carbapenem-nonsusceptible strains,25(73.5％)strains were susceptible to mecillinam,including 15 strains producing metallo-β-lactamase.PCR assay identified carbapenemase genes in 21 of the 34 carbapenem-nonsusceptible strains,including blaNDM(14 strains),blaIMP(5 strains)and blaKPC(2 strains).Compared with the strains isolated in 2018,the ECC strains isolated in 2019 and 2020 showed significantly higher resistance rates to imipenem and ceftazidime-avibactam(P＜0.05),primarily associated with the production of NDM.Among the ECC strains resistant to third-generation cephalosporins,20.4％were resistant to imipenem and meropenem,while 4.9％and 8.7％were resistant to amikacin and mecillinam,respectively,and 9.7％were nonsusceptible to tigecycline.Conclusions The ECC isolates in 2019 and 2020 showed increasing resistance rates to carbapenems and ceftazidime-avibactam due to the production of metallo-β-lactamases.Some of the metallo-β-lactamase-producing ECC isolates were susceptible to mecillinam.

Seven indole alkaloid glycosides containing a 1'-(4″-hydroxy-3″,5″-dimethoxyphenyl)ethyl unit (-) were isolated from an aqueous extract of leaves (da qing ye). Their structures were determined by spectroscopic data analysis combined with enzymatic hydrolysis as well as comparison of their experimental CD (circular dichroism) and calculated ECD (electrostatic circular dichroism) spectra. Based on analysis of and/or Cotton effect (CE) data of -, two simple roles to assign location and/or configuration of -glycopyranosyloxy and 1'-(phenyl)ethyl units in the indole alkaloid glycosides are proposed. Stereoselectivity in plausible biosynthetic pathways of - is discussed. Compounds and and their mixture in a 3:2 ratio showed activity against KCNQ2 in CHO cells. The mixture of and (3:2) exhibited antiviral activity against influenza virus H1N1 PR8 with IC 64.7 μmol/L (ribavirin, IC 54.3 μmol/L), however, the individual or was inactive. Preliminary structure-activity relationships were observed.

Eight new C-diterpenoid alkaloid arabinosides, named aconicarmichosides E-L (-), were isolated from an aqueous extract of the lateral roots of (Fu Zi). Their structures were determined by spectroscopic and chemical methods including 2D NMR experiments and acid hydrolysis. Compounds -, together with the previously reported four neoline 14--arabinosides from the same plant, represent the only examples of glycosidic diterpenoid alkaloids so far. At a dose of 1.0 mg/kg (i.p.), as compared with the black control, compounds , , and - exhibited analgesic effects with >65.6% inhibitions against acetic acid-induced writhing of mice. Structure-activity relationship was also discussed.

Five new sulfur-enriched alkaloids isatithioetherins A-E (-), and two pairs of scalemic enantiomers (+)- and (-)-isatithiopyrin B ( and ) and isoepigoitrin and isogoitrin and ), along with the known scalemic enantiomers epigoitrin and goitrin ( and ), were isolated and characterized from an aqueous extract of the roots. Their structures were determined by extensive spectroscopic data analysis, including 2D NMR and theoretical calculations of electronic circular dichroism (ECD) spectra based on the quantum-mechanical time-dependent density functional theory (TDDFT). Compounds - represent a novel group of sulfur-enriched alkaloids, biogenetically originating from stereoselective assemblies of epigoitrin-derived units. Isolation and structure characterization of and support the postulated biosynthetic pathways for the diastereomers and a rare thio-Diels-Alder reaction. Compounds and showed antiviral activity against the influenza virus A/Hanfang/359/95 (H3N2, IC 0.60 and 1.92 μmol/L) and the herpes simplex virus 1 (HSV-1, IC 3.70 and 2.87 μmol/L), and also inhibited Coxsackie virus B3 (IC 0.71 μmol/L).

Three pairs of glycosidic 8,4'-oxyneolignane diastereoisomers, named isatioxyneolignosides A-F (-), were isolated from an aqueous extract ofroots. Their structures and absolute configurations were elucidated by comprehensive spectroscopic data analysis and enzyme hydrolysis. The validity of Δvalues to distinguishandaryl glycerol units and Cotton effects at 235±5 nm to determine absolute configurations at C-8 in-and their aglycones (-) are discussed.

Six new indole alkaloid sulfonic acids (-), together with two analogues (and) that were previously reported as synthetic products, were isolated from an aqueous extract of theroot. Their structures including the absolute configurations were determined by spectroscopic data analysis, combined with enzyme hydrolysis and comparison of experimental circular dichroism and calculated electronic circular dichroism spectra. In the preliminary assay, compoundsandshowed antiviral activity against Coxsackie virus B3 and influenza virus A/Hanfang/359/95 (H3N2), respectively.

A pair of new diphenyl glycerol ether enantiomers (-)-and (+)-and two new methyl benzamidobenzoatesand, named (-)-()- and (+)-()-isatindigotrioic acid [(-)-and (+)-] and isatindigoticamides A () and B (), respectively, were isolated from an aqueous decoction of the roots of(ban lan gen). Their structures were elucidated by spectroscopic data analysis including 2D NMR experiments. The absolute configurations of (-)-and (+)-were assigned based on the CD exciton chirality method. Compoundsandexhibited antiviral activities against HSV-1 with ICvalues of 4.87 and 25.87 μmol/L, respectively. Compoundwas also found active against Coxsackie virus B3 and LPS-induced NO production.

Three new sesquiterpene glycosides, named codonopsesquilosides A-C (1-3), were isolated from an aqueous extract of the dried roots of Codonopsis pilosula. Their structures including absolute configurations were determined by spectroscopic and chemical methods. These glycosides are categorized as C15 carotenoid (1), gymnomitrane (2), and eudesmane (3) types of sesquiterpenoids, respectively. Compound 1 is the first diglycoside of C15 carotenoids to be reported. Compound 2 represents the second reported example of gymnomitrane-type sesquiterpenoids from higher plants. The absolute configurations were supported by comparison of the experimental circular dichroism (CD) spectra with the calculated electronic CD (ECD) spectra of 1-3, their aglycones, and model compounds based on quantum-mechanical time-dependent density functional theory. The influences of the glycosyls on the calculated ECD spectra of the glycosidic sesquiterpenoids, as well as some nomenclature and descriptive problems with gymnomitrane-type sesquiterpenoids are discussed.