Lipopolysaccharides (LPS) are major outer membrane components of Gram-negative bacteria. Unlike most Gram-negative bacteria, Acinetobacter baumannii can still survive and acquire polymyxin resistance after complete loss of LPS. Previous studies of LPS-deficient Acinetobacter baumannii mostly focused on LPS-deficient strains induced by polymyxin, whose background was complex and unstable. To investigate LPS loss-mediated polymyxin resistant-Acinetobacter baumannii, this study constructed a stable and clear background LPS-deficient strain by knocking out lpxC gene in Acinetobacter baumannii ATCC 19606 with CIRSPR/Cas9, and then studied the phenotypic changes of the lpxC-deficient strain including morphology, growth rate, antibiotic susceptibility, virulence, membrane permeability, and membrane potential. Animal experiments were approved by the Animal Care and Welfare Committee Institute of Medicinal Biotechnology, CAMS and PUMC (approval number: IMB-20240119D₉). The results indicated that the lpxC gene of Acinetobacter baumannii ATCC 19606 was successfully knocked out. After losing the lpxC, the strain underwent the morphological change from rod-shaped to spherical. Furthermore, it leads to reduced growth rate, enhanced membrane permeability, decreased membrane potential, lower virulence, and increased antibiotic susceptibility to β-lactams, quinolones, aminoglycosides, macrolides, glycopeptides. The lpxC deletion results in significant changes in membrane homeostasis and adaptability of Acinetobacter baumannii. Understanding the phenotypic changes of colistin-resistant Acinetobacter baumannii mediated by LPS loss is useful for exploring the resistance mechanism of Acinetobacter baumannii and developing new therapeutic strategies.

OBJECTIVES: To investigate the risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture and establish a nomogram model for predicting the risk of neonatal asphyxia. METHODS: A retrospective study was conducted with 613 cases of neonatal asphyxia treated in 20 cooperative hospitals in Enshi Tujia and Miao Autonomous Prefecture from January to December 2019 as the asphyxia group, and 988 randomly selected non-asphyxia neonates born and admitted to the neonatology department of these hospitals during the same period as the control group. Univariate and multivariate analyses were used to identify risk factors for neonatal asphyxia. R software (4.2.2) was used to establish a nomogram model. Receiver operator characteristic curve, calibration curve, and decision curve analysis were used to assess the discrimination, calibration, and clinical usefulness of the model for predicting the risk of neonatal asphyxia, respectively. RESULTS: Multivariate logistic regression analysis showed that minority (Tujia), male sex, premature birth, congenital malformations, abnormal fetal position, intrauterine distress, maternal occupation as a farmer, education level below high school, fewer than 9 prenatal check-ups, threatened abortion, abnormal umbilical cord, abnormal amniotic fluid, placenta previa, abruptio placentae, emergency caesarean section, and assisted delivery were independent risk factors for neonatal asphyxia (P<0.05). The area under the curve of the model for predicting the risk of neonatal asphyxia based on these risk factors was 0.748 (95%CI: 0.723-0.772). The calibration curve indicated high accuracy of the model for predicting the risk of neonatal asphyxia. The decision curve analysis showed that the model could provide a higher net benefit for neonates at risk of asphyxia. CONCLUSIONS The risk factors for neonatal asphyxia in Hubei Enshi Tujia and Miao Autonomous Prefecture are multifactorial, and the nomogram model based on these factors has good value in predicting the risk of neonatal asphyxia, which can help clinicians identify neonates at high risk of asphyxia early, and reduce the incidence of neonatal asphyxia.
Infant, Newborn ; Humans ; Male ; Pregnancy ; Female ; Nomograms ; Retrospective Studies ; Cesarean Section ; Risk Factors ; Asphyxia Neonatorum/etiology*

Objective:To explore the risk factors of urinary incontinence (UI) in China by using random forest algorithm, and to evaluate the predictive effect of each risk factor on UI.Methods:A baseline survey with a multistage stratified cluster sampling design was conducted between February 2014 and January 2016, and followed up by telephone from June to December 2018. A total of 55 477 adult women from six provinces of China participated the survey. According to the ratio of 1:1, under sampling method was used to randomly select the same number of women as UI from the non UI women. The data were randomly divided into training set and verification set according to 7:3. The training set was used to establish the random forest model, which including the candidate variables with P<0.2 in univariate analysis, and the verification set was used to verify the predictive effects. Results:A total of 30 658 patients (55.26%, 30 658/55 477) completed the follow-up, the median follow-up time was 3.7 years. Among the 24 985 women without UI at baseline, 1 757 (7.03%, 1 757/24 985) had UI at followed up, including 1 117 (4.47%, 1 117/24 985) with stress UI, 243 (0.97%, 243/24 985) with urgency UI and 397 (1.59%, 397/24 985) with mixed UI. When fixed the number of features as 2 and the number of random trees as 300 in the random forest model, the out of bag error rate estimation was the lowest; with such parameter settings, the classification accuracy was 64.3%, the sensitivity was 64.2%, and the specificity was 64.4%. The top10 predictive UI factors that screening by the variable importance measure in random forest model were obtained as follows: age, parity, delivery pattern, body mass index (BMI), menopause, history of diabetes, education level, history of pelvic surgery, regions, and marital status.Conclusion:We identified the top10 predictive UI factors that screening by the variable importance in random forest model as follows: age, parity, delivery pattern, BMI, menopause, history of diabetes, education level, history of pelvic surgery, regions, and marital status.

OBJECTIVE: To investigate the clinical features and outcome of neonatal acute respiratory distress syndrome (ARDS) in southwest Hubei, China. METHODS: According to the Montreux definition of neonatal ARDS, a retrospective clinical epidemiological investigation was performed on the medical data of neonates with ARDS who were admitted to Department of Neonatology/Pediatrics in 17 level 2 or level 3 hospitals in southwest Hubei from January to December, 2017. RESULTS: A total of 7 150 neonates were admitted to the 17 hospitals in southwest Hubei during 2017 and 66 (0.92%) were diagnosed with ARDS. Among the 66 neonates with ARDS, 23 (35%) had mild ARDS, 28 (42%) had moderate ARDS, and 15 (23%) had severe ARDS. The main primary diseases for neonatal ARDS were perinatal asphyxia in 23 neonates (35%), pneumonia in 18 neonates (27%), sepsis in 12 neonates (18%), and meconium aspiration syndrome in 10 neonates (15%). Among the 66 neonates with ARDS, 10 neonates (15%) were born to the mothers with an age of ≥35 years, 30 neonates (45%) suffered from intrauterine distress, 32 neonates (49%) had a 1-minute Apgar score of 0 to 7 points, 24 neonates (36%) had abnormal fetal heart monitoring results, and 21 neonates (32%) experienced meconium staining of amniotic fluid. Intraventricular hemorrhage was the most common comorbidity (12 neonates), followed by neonatal shock (9 neonates) and patent ductus arteriosus (8 neonates). All 66 neonates with ARDS were treated with mechanical ventilation in addition to the treatment for primary diseases. Among the 66 neonates with ARDS, 10 died, with a mortality rate of 15% (10/66), and 56 neonates were improved or cured, with a survival rate of 85% (56/66). CONCLUSIONS Neonatal ARDS in southwest Hubei is mostly mild or moderate. Perinatal asphyxia and infection may be the main causes of neonatal ARDS in this area. Intraventricular hemorrhage is the most common comorbidity. Neonates with ARDS tend to have a high survival rate after multimodality treatment.
China ; Female ; Humans ; Infant, Newborn ; Meconium Aspiration Syndrome ; Pregnancy ; Respiratory Distress Syndrome, Newborn ; Retrospective Studies

Objective To explore and establish accurate detection quality control method of source positioning and timer precision for afterloading equipment. Methods The source positioning detection device was made of hd camera,EBT3 disposable film and steel rule,collecting source in each resident point for video images and film. Accurate measurement of radioactive source positioning and timer accuracy, including the timing absolute error and linear error through analysis of image sampling rate. After the film grayscale distribution analysis,comparison between film gray peak position and the measurement of resident point geometry,got the stay point source physics and radiation center deviation. Results Radioactive source physics and radiation center deviation was (-0.33± 0. 10) mm;For all default dwell time,timer average absolute deviation was (0.22±0. 02) s,linear fitting result was y=x-0. 226,R2=1,timing linear error was-0. 01％ Conclusions established detection means through the video images and film exposure quantitative analysis for accurately determination of source positioning,dwell time and source radiation center precision. After experimental testing the machine precision satisfied the requirement of clinical use.

UHPLC-QTOF-MS was applied to non-targeted metabolomics study of mice infected with K. pneumoniae ATCC^® BAA 2146 to discover potential biomarkers and metabolic pathways that are associated with sepsis. Fifty-eight metabolites were identified by principal components analysis (PCA) and partial least-squares discriminant analysis (OPLS-DA), which was combined with variable projection importance (VIP) and nonparametric test. Eighteen of the 58 metabolites were further found to be involved in 8 metabolic pathways, including nicotinate and nicotinamide metabolism, pyrimidine metabolism, vitamin B6 metabolism, taurine and hypotaurine metabolism, arginine and proline metabolism, alanine, aspartate and glutamate metabolism, D-glutamine and D-glutamate metabolism and glycerophospholipid metabolism.

Objective To investigate the feasibility of P16 immunohistochemistry combined with routine pathology in judging the residual lesion of high grade cervical intraepithelial neoplasia.Methods Patients with cervical conization for high grade cervical intrapithelial neoplasia in this hospital from January 2014 to May 2016 were chose and divided into P16 immunohistochemical detection combined with pathological diagnosis group and pathological evaluation group according to patient's motivation.Patients with residual margins were treated in accordance with the clinical guidelines and TCT was followed up for 6 months after no margin.Then sensitivity and accuracy of two group were analyzed by gold standard of follow-up results.Results 104 patients in P16 immunohistochemical detection combined with pathological diagnosis group were negative in TCT test after 6 month of following up after surgery.However,at the time of 6 months follow-up after surgery,7 patients of 112 patients have been diagnosed with positive by TCT in pathological evaluation group.The Sensitivity and accuracy in P16 immunohistochemical detection combined with pathological diagnosis group were 100％ which were higher than pathological evaluation group.Conclusion P16 immunohistochemical detection combined with conventional pathology can accurately diagnose the cervical cutting edge of conization.

Objective To compare the relative dose of small fields measured by clinically common detectors and those obtained from Monte Carlo simulation in order to obtain the accurate measurement method, and to modify the inappropriate detectors.Methods The percentage depth-dose distribution curve and profile (flatness and symmetry) curves were collected at 2 cm×2 cm, 3 cm×3 cm, and 4 cm×4 cm under 6-MV X-ray of Trilogy linear accelerator by CC13, PFD, SFD, and blue phantom.The results were compared with the stimulation results from Monte Carlo method (the current gold standard).The correction factors for the detectors with large error were calculated to provide reference data for clinical practice.Results The results measured by SFD detector were most close to the results from Monte Carlo simulation.The measurement errors of CC13 and PFD detectors were large.The correction factor in the penumbra for CC13 and PFD detector was 0.664-1.499.Conclusions SFD detector is better than CC13 and PFD detector in the measurement of small fields, but CC13 and PFD detector can provide reference data for clinical practice after the corresponding correction.

Objective To determine the impact of emotional intelligence, resilience and psychological empowerment of clinical nurses on self-directed learning competence. Methods Totally 270 clinical nurses from six tertiary first-class hospitals in Tianjin City were investigated with Nursing Staff Self-directed Learning Competence Scale, Emotional Intelligence Scale, the Conner-Davidson Resilience Scale and Psychological Empowerment Questionnaire, and then, the datum was analyzed by professional statistical software. Results The total score of self-directed learning competence was (124.96 ± 21.73) points, the total mean score was (3.68 ± 0.64) points, while the mean score of different dimension from high to low was self-motivational belief (3.78±0.67) points, self-monitoring and regulation (3.65 ± 0.69) points, task analysis (3.61 ± 0.76) points, self-evaluation (3.47 ± 0.72) points. The total mean score of emotional intelligence was (3.87±0.53) points, the total mean score of resilience was (2.74±0.54) points, the total mean score of psychological empowerment was (3.74±0.57) points. The total score and score of all dimensions of emotional intelligence, resilience as well as psychological empowerment were positively correlated to self-directed learning competence(r=0.269-0.650, P<0.01). There was a statistically significant difference of total mean score of nurses′ self-directed learning competence from different department in this investigation, F=8.407, P <0.01, while there was no statistically significant difference of total mean score of nurses′self-directed learning competence by different gender, different marital status, different cultural level, different professional and technical titles and different establishment, F or t values was-1.626,-0. 0387, 0.882, 0.926 and 1.125 respectively, P > 0.05. Self-reliance, self-determination, emotional use, self-efficacy, perseverance were indicated as predictive factors of self-directed learning competence among clinical nurses, which explained 58.5 percent of the variance. Conclusions The self-directed learning competence of clinical nurses was at moderate level. The self-directed learning competence can be influenced by emotional intelligence, resilience and psychological empowerment. So we can enhance their self-directed learning competence by improving emotional intelligence,resilience and psychological empowerment.

Objective To evaluate continuous improvement of portable domestic pelvic floor neuromuscular electrical stimulation on the pelvic floor function of patients with stress urinary incontinence after short-term pelvic floor electrophysiological treatment in hospital.Methods Totally 60 women with stress urinary incontinence were recruited for this randomized controlled trial.The control group including a total of 30 patients,only received 4 weeks pelvic floor electrophysiological treatment in the hospital.Family consolidation treatment group (experimental group) including 30 patients,after 4-week treatment in hospital,received 12-week of pelvic floor neuromnuscular electrical stimulation using portable electrical stimulator at home under the guidance of doctors.In post-treatment 6 months and 9 months,1-hour pad test was measured for urine leakage,pelvic floor electrical physiological parameters were assessed,and subjective improvement of symptoms of urinary incontinence were evaluated.All these data were analysed to compare the effect of the two groups.Results In 9 months after treatment,average change of urine leakage,the control group and experiment group were (75±24)％ versus (99±3)％,the difference was statistically significant (P＜0.01).In the experiment group,strength of type Ⅰ muscle (4.4±0.7),strength of type Ⅱ muscle (4.8±0.4) and pelvic floor dynamic pressure [(96± 12) cmH2O,1 cmH2O=0.098 kPa] were better than those of control group [3.2± 1.0,4.3 ± 0.9,(86 ± 10) cmH2O,respectively],the differences were statistically significant (P＜0.01).Subjective outcome,the control group and experiment group were (6.5 ±2.9) versus (1.8 ± 1.7),subjective outcome between the two groups had significant difference (P＜0.01).Conclusion After short-term pelvic floor electrophysiological treatment in hospital,the portable domestic pelvic floor neuromuscular electrical stimulation in patients with stress urinary incontinence is helpful to continuous improvement of pelvic floor function.