Biofilms are closely associated with the tough healing and dysfunctional inflammation of chronic wounds. Photothermal therapy (PTT) emerged as a suitable alternative which could destroy the structure of biofilms with local physical heat. However, the efficacy of PTT is limited because the excessive hyperthermia could damage surrounding tissues. Besides, the difficult reserve and delivery of photothermal agents makes PTT hard to eradicate biofilms as expectation. Herein, we present a GelMA-EGF/Gelatin-MPDA-LZM bilayer hydrogel dressing to perform lysozyme-enhanced PTT for biofilms eradication and a further acceleration to the repair of chronic wounds. Gelatin was used as inner layer hydrogel to reserve lysozyme (LZM) loaded mesoporous polydopamine (MPDA) (MPDA-LZM) nanoparticles, which could rapidly liquefy while temperature rising so as to achieve a bulk release of nanoparticles. MPDA-LZM nanoparticles serve as photothermal agents with antibacterial capability, could deeply penetrate and destroy biofilms. In addition, the outer layer hydrogel consisted of gelatin methacryloyl (GelMA) and epidermal growth factor (EGF) promoted wound healing and tissue regeneration. It displayed remarkable efficacy on alleviating infection and accelerating wound healing in vivo. Overall, the innovative therapeutic strategy we came up with has significant effect on biofilms eradication and shows promising application in promoting the repair of clinical chronic wounds.

Objective: To assess the effectiveness of transanal drainage tube (TDT) in reducing the incidence of anastomotic leak following anterior resection in patients with rectal cancer. Methods: We conducted a systematic search for relevant studies published from inception to October 2022 across multiple databases, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP. Meta-analysis was performed using Review Manager 5.4 software. The primary outcomes included total incidence of anastomotic leak, grade B and C anastomotic leak rates, reoperation rate, anastomotic bleeding rate, and overall complication rate. Results: Three randomized controlled trials involving 1115 patients (559 patients in the TDT group and 556 in the non-TDT group) were included. Meta-analysis showed that the total incidences of anastomotic leak and of grade B anastomotic leak were 5.5% (31/559) and 4.5% (25/559), respectively, in the TDT group and 7.9% (44/556) and 3.8% (21/556), respectively, in the non-TDT group. These differences are not statistically significant (P=0.120, P=0.560, respectively). Compared with the non-TDT group, the TDT group had a lower incidence of grade C anastomotic leak (1.6% [7/559] vs. 4.5% [25/556]) and reoperation rate (0.9% [5/559] vs. 4.3% [24/556]), but a higher incidence of anastomotic bleeding (8.2% [23/279] vs. 3.6% [10/276]). These differences were statistically significant (P=0.003, P=0.001, P=0.030, respectively). The overall complication rate was 26.5%(74/279) in the TDT group and 27.2% (75/276) in the non-TDT group. These differences are not statistically significant (P=0.860). Conclusions: TDT did not significantly reduce the total incidence of anastomotic leak but may have potential clinical benefits in preventing grade C anastomotic leak. Notably, placement of TDT may increase the anastomotic bleeding rate.
Humans ; Anastomotic Leak/etiology* ; Rectal Neoplasms/complications* ; Drainage ; Anastomosis, Surgical/adverse effects* ; Reoperation/adverse effects* ; Hemorrhage ; Retrospective Studies

Platelets are reprogrammed by cancer via a process called education, which favors cancer development. The transcriptional profile of tumor-educated platelets (TEPs) is skewed and therefore practicable for cancer detection. This intercontinental, hospital-based, diagnostic study included 761 treatment-naïve inpatients with histologically confirmed adnexal masses and 167 healthy controls from nine medical centers (China, n = 3; Netherlands, n = 5; Poland, n = 1) between September 2016 and May 2019. The main outcomes were the performance of TEPs and their combination with CA125 in two Chinese (VC1 and VC2) and the European (VC3) validation cohorts collectively and independently. Exploratory outcome was the value of TEPs in public pan-cancer platelet transcriptome datasets. The AUCs for TEPs in the combined validation cohort, VC1, VC2, and VC3 were 0.918 (95% CI 0.889-0.948), 0.923 (0.855-0.990), 0.918 (0.872-0.963), and 0.887 (0.813-0.960), respectively. Combination of TEPs and CA125 demonstrated an AUC of 0.922 (0.889-0.955) in the combined validation cohort; 0.955 (0.912-0.997) in VC1; 0.939 (0.901-0.977) in VC2; 0.917 (0.824-1.000) in VC3. For subgroup analysis, TEPs exhibited an AUC of 0.858, 0.859, and 0.920 to detect early-stage, borderline, non-epithelial diseases and 0.899 to discriminate ovarian cancer from endometriosis. TEPs had robustness, compatibility, and universality for preoperative diagnosis of ovarian cancer since it withstood validations in populations of different ethnicities, heterogeneous histological subtypes, and early-stage ovarian cancer. However, these observations warrant prospective validations in a larger population before clinical utilities.
Humans ; Female ; Blood Platelets/pathology* ; Biomarkers, Tumor/genetics* ; Ovarian Neoplasms/pathology* ; China

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

As d-amino acids play important roles in the physiological metabolism of bacteria, combination of d-amino acids with antibiotics may provide synergistic antibacterial activity. The aim of the study was to evaluate and activity of d-serine alone and in combination with -lactams against methicillin-resistant (MRSA) strains, and to explore the possible sensitization mechanisms. The activity of d-serine, -lactams alone and in combinations was evaluated both by standard MICs, time-kill curves and checkerboard assays, and by murine systemic infection model as well as neutropenic thigh infection model. An synergistic effect was demonstrated with the combination of d-serine and -lactams against MRSA standard and clinical strains. Importantly, the combinations enhanced the therapeutic efficacy in the animal models as compared to -lactam alone groups. Initial mechanism study suggested possible revision of d-alanine-d-alanine residue to d-alanine-d-serine in peptidoglycan by adding of d-alanine in the medium, which may cause decreased affinity to PBPs during transpeptidation. In conclusion, d-serine had synergistic activity in combination with -lactams against MRSA strains both and . Considering the relatively good safety of d-serine alone or in combination with -lactams, d-serine is worth following up as new anti-MRSA infection strategies.

Two new polyketides, chinoketides A and B (1 – 2) with a known compound xylarphthalide A (3), were isolated from the solid medium of the endophytes from the leaves of the relic plant Distylium chinense with the “black-box” co-culture method, and the structures of two new compounds were elucidated by NMR, MS and CD spectra. And the absolute configurations of chinoketides A (1) and B (2) were determined as 2R,3R,8S and 5R,6S by calculating their ECD spectra to compare with the experimental CD spectra. Finally, the antimicrobial activities were evaluated to Erwinia carotovora sub sp. Carotovora (Jones) Bersey et al, and the results showed that compounds 1 – 3 displayed the antimicrobial activities with MIC value at 20.5, 30.4 and 10.2 µg/mL.
Coculture Techniques ; Endophytes ; Methods ; Pectobacterium carotovorum ; Plants ; Polyketides

BACKGROUND AND PURPOSE: Self-rated health (SRH) is a consistent and strong predictor of all-cause and cardiovascular mortality in various populations. However, the associations between SRH measures and risk of first-ever or recurrent stroke were rarely explored. We thus aim to prospectively investigate the associations between SRH measures and risk of total and subtypes of stroke in Chinese population. METHODS: A total of 494,113 participants from the China Kadoorie Biobank without prior heart diseases or cancer (486,541 without stroke and 7,572 with stroke) were followed from baseline (2004 to 2008) until December 31, 2013. General and age-comparative SRH were obtained from baseline questionnaires. First-ever stroke or recurrent events were ascertained through linkage to disease registry system and health insurance data. RESULTS: We identified 27,662 first-ever stroke and 2,909 recurrent events during an average of 7.0 years of follow-up. Compared with excellent general SRH, the hazard ratios (HRs) and 95% confidence intervals (CIs) for first-ever stroke associated with good, fair, and poor general SRH were 1.04 (1.00 to 1.08), 1.19 (1.15 to 1.23), and 1.49 (1.42 to 1.56) in the multivariate model, respectively. Compared with better age-comparative SRH, the HRs (95% CIs) of same and worse age-comparative SRH were 1.13 (1.10 to 1.17) and 1.51 (1.45 to 1.58), respectively. The relations of SRH measures with ischemic stroke, hemorrhagic stroke, and recurrent stroke were similar to that with total first-ever stroke. However, the magnitude of associations was much stronger for fatal stroke than for non-fatal stroke. CONCLUSIONS: This large-scale prospective cohort suggests that self-perceived health status is associated with incident stroke, regardless of stroke subtype.
Adult* ; Asian Continental Ancestry Group* ; China* ; Cohort Studies ; Follow-Up Studies ; Heart Diseases ; Humans ; Insurance, Health ; Mortality ; Prospective Studies ; Stroke*

Objective: This paper develops a methodology for steady and orderly expansion of the designated medical insurance drugstores. Methods:With the help of grid management ideology, the paper uses ArcGIS and its function modules to define and visualize the scope of the medical insurance drugs service with the guidance of fairness and efficiency through analyzing the basic data including population distribution, the physical distribution of drug-stores and soon. Results:In order to figure out the procedure of the methodology,the key problems were all solved, including defining and visualizing the scope of the medical insurance drugs service area,,checking and ratifying the scope that need to supplement or increase the medical insurance drugstores, making measures for the annual imple-mentation and confirming a selection principle for designated medical insurance drugstores. Conclusion:The Method-ology guided by fairness and efficiency of the medicare designated pharmacy layout planning is practical and feasible, which can probably provide a reference for increasing the designated medical insurance drugstores steadily and orderly.

Objective: To investigate the current situation of drug supply and determinants of drug shortage in primary health institutions in Anhui province. Methods:Primary health institutions in Anhui province were selected as the main research subjects. One hundred and six (106) primary health institutions from three areas/districts in Anhui province namely northern Anhui,Central Anhui,and Southern Anhui were selected with stratified random sampling as the first sample,and 54 pharmaceutical producing enterprises and 62 pharmaceutical trading enterprises were selected with convenience sampling method as the second sample. The survey was conducted by issuing questionnaires to record views of the respondents to help understand the current situation of drug supply from the first sample and the main de-terminants and solutions of drug shortage from two samples. Results:13% of the primary health institutions still suffer from serious shortage of drug supply; the drug distribution rate varies greatly between units, and 19% of the primary health institutions have a drug distribution rate below 70%,and all primary health institution within the scope of inves-tigation experienced drug shortages. The frequency of choices of determinants of drug shortage were in sequence of or-der:drug demand instability (19.20%), drugs have a new and higher profit alternative (15.94%), etc.; The fre-quency of choices of solutions of drug shortage of primary health institution were in sequence of order:to improve the national list of essential medicines(12.78%),appropriate improvement in efficacy the low-priced varieties(with cura-tive effect) (12.03%),etc. Conclusions:Primary health institutions suffer from drug shortage issue widely,and the reasons for the shortage of drugs are more complicated;the government should continue to implement relevant policies, comprehensively improving the primary health institution drug supply mechanisms in all to prevent drug shortages.

Objective: To compare the middle and long term clinical outcomes of one-stop hybrid coronary revascularization, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in treating the patients with multivessel coronary artery disease; to explore the optimal indication of one-stop hybrid technology. Methods: Our research included in 3 groups: Hybrid group, n=141 patients received one-stop hybrid coronary revascularization in our hospital from 2006-06 to 2010-16. Meanwhile, 5797 patients received CABG and 4254 received PCI, the major pre-operative risk factors were studied by Logistic regression analysis to calculate propensity score, adjacent matching was used to respectively select 141 subjects from CABG and PCI patients to make 1:1 match with Hybrid group as CABG group and PCI group. EuroSCORE and SYNTAX score were used to make risk stratification in all 3 groups. By EuroSCORE system: low risk ≤ 2, medium risk (3-5) and high risk ≥ 6; by SYNTAX score system: low risk ≤ 24, medium risk (25-29) and high risk ≥ 30. The incidence of major adverse cardiac/cerebral vascular events (MACCE) was compared among 3 groups at different risk stratifications. Results: The mean follow-up time was 4.5 years up to 2015-01. The overall incidence of MACCE was lower in Hybrid group (9.9％) than PCI group (27.7％), P<0.001; while it was similar between Hybrid group and CABG group (19.1％), P=0.150. By EuroSCORE stratification, the incidence of MACCE in low risk and medium risk patients were similar among 3 groups; while in high risk patients, the incidence was lower in Hybrid group than both CABG group (P=0.017) and PCI group (P<0.001). By SYNTAX score stratification, the incidence of MACCE in low risk and medium risk patients were similar among 3 groups; while in high risk patients, the incidence was lower in Hybrid group than PCI group (P<0.001), it was similar between Hybrid group and CABG group (P=0.355). Conclusion: One-stop hybrid technology had the better middle and long term outcomes for treating multivessel coronary artery disease patients with high risk stratification, which provided an alternative strategy in clinical practice.