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.

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).

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.

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.

Objective To explore the application effect of PDCA cycles on the normal limb position of stroke patients with hemiplegia. Methods The stroke patients with hemiplegia (128 cases) were selected as study subjects. Patients(62 cases)during January to September 2014 were set as the control group,and received routine nursing care. Patients(66 cases)during October 2014 to July 2015 were set as the experimental group,and used PDCA cycles management on the normal limb position additionally. The application effect of PDCA cycles on the normal limb position was evaluated through comparing two groups with qualification rates of normal limb position and incidence of complications. Results The qualification rates of normal limb position in the control group was 38.71%(24/62), which was higher than that of the control group, which was 75.76% (50/66) (χ2=16.504, P<0.01). The complications occurred in the control group were strephenopodia (11 cases), foot drop (16 cases), dislocation of shoulder (9 cases), omodynia (27 cases) and myospasm (34 cases), and they were 3 cases, 7 cases, 2 cases, 15 cases and 18 cases in the experimental group respectively. The incidence of complications was lower than those of the control group (χ2=4.001-8.961, P < 0.05), and the difference was statistically significant between two groups. Conclusions PDCA cycles management could improve the qualification rates of normal limb position and reduce the incidence of complications, which was beneficial to the recovery of limb function.

Objective To explore the values of apparent diffusion coefficients (ADC) in staging the lesions of multiple sclerosis (MS) through analysing the differences of ADC in different types of lesions.Methods 137 lesions identified in 29 patients with MS,were characterized by their enhancement pattern on contrast-enhanced T1-weighted MR images and whether they were changing in appearance, size or signal.The lesions were classified into four groups:homogeneously enhancing lesions (HELs), ring-enhancing lesions (RELs), active nonenhancing lesions (ANELs), and inactive nonenhancing lesions (INELs).The mean ADC values for each type of lesions were calculated and compared.Results The ADC values for HELs, RELs, ANELs and INELs were (91.09±13.63)× 10 5 · m2 · s-1, (105.66±9.92) × 10-5 · m2 · s-1, (136.80±20.31) × 10-5 · m2 · s-1 and (127.46±13.65) ×10-5 · m2 · s-1.There were significant differences between the ADC values of any two groups in the four groups except the ADC values between ANELs and INELs.Conclusion ADC values are useful to differentiate each type of lesion,which can help stage the lesions of MS.