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ObjectiveTo investigate the effect of Shaoyaotang on fecal metabolites in rats with ulcerative colitis （UC） induced by 2，4，6-trinitrobenzenesulfonic acid （TNBS） based on liquid chromatography-mass spectrometry （LC-MS）. MethodMale SPF SD rats were randomly divided into normal group， model group and Shaoyaotang group （11.1 g·kg-1）. Except for normal group， UC rat model was induced by TNBS， and each group was given normal saline except Shaoyaotang group. All groups were treated for 7 days， and the general condition and disease activity index （DAI） were observed. Hematoxylin-eosin （HE） staining was used to observe the histopathological changes of colon， and the protein expressions of interleukin-8 （IL-8） and interleukin-22 （IL-22） in colon tissue were detected by immunohistochemistry （IHC）. Rat fecal samples were detected by LC-MS， and the data were analyzed by principal component analysis （PCA） and partial least squares discriminant analysis （PLS-DA）. Human Metabolome Database （HMDB） and Kyoto Encyclopedia of Genes and Genomes （KEGG） were searched to screen differential metabolites in combination with literature reference. Then， pathway enrichment analysis was conducted using Metabo Analyst 5.0. ResultShaoyaotang （ig） decreased the DAI of UC rats. Compared with the normal group， the model group had damaged colonic mucosa structure， submucosal inflammatory cell infiltration， increased protein expressions of IL-8 （P<0.01） and IL-22 （P<0.05） in colon tissue. Compared with the conditions in the model group， the colonic damage was alleviated in the Shaoyaotang group， and the protein expressions of IL-8 and IL-22 in colon tissue were decreased （P<0.01）. After screening， 15 differential metabolites were identified from the Shaoyaotang group， and the involved pathways mainly included biosynthesis of unsaturated fatty acids， linoleic acid metabolism， terpenoid backbone biosynthesis， porphyrin and chlorophyll metabolism， amino sugar and nucleotide sugar metabolism， pyrimidine metabolism and steroid hormone biosynthesis. ConclusionShaoyaotang has a therapeutic effect on UC， and its anti-inflammatory effect may be related to improving lipid metabolism and regulating the metabolism of cofactors and vitamins as well as the abnormal carbohydrate metabolism.
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ObjectiveTo investigate the role of cyclic adenosine monophosphate （cAMP）/protein kinase A （PKA）/cAMP-response element binding protein （CREB） signaling pathway in water metabolism and intestinal epithelial permeability in ulcerative colitis （UC） and the intervention mechanism of Shaoyaotang based on the theory of large intestine governing fluids. MethodSixty male SD rats were divided into blank group， model group， mesalazine group （0.42 g·kg-1）， Shaoyaotang low-dose group （11.1 g·kg-1）， Shaoyaotang medium-dose group （22.2 g·kg-1） and Shaoyaotang high-dose group （44.4 g·kg-1）， with 10 in each group. The UC rat model of internal retention of dampness-heat was established by compound factors. The blank group and the model group were given normal saline （ig）. The mesalazine group was given mesalazine （ig）， and Shaoyaotang low-， medium- and high-dose groups were administrated with corresponding doses of Shaoyaotang （ig）. The treatment lasted for 14 days. The diarrhea score and fecal moisture content of rats in each group were observed. The contents of diamine oxidase （DAO） and D-lactic acid in plasma were detected by enzyme-linked immunosorbent assay （ELISA）. The protein expressions of aquaporin （AQP）8， AQP4， ZO-1 and Occludin in colon tissues were detected by immunohistochemistry， while those of cAMP， PKA and CREB in colon tissues were determined by Western blot. ResultCompared with the normal group， the model group had elevated diarrhea score and fecal moisten content （P<0.01）， increased contents of DAO and D-lactic acid in plasma （P<0.01） and decreased protein expressions of ZO-1， Occludin， AQP8， AQP4， cAMP， PKA and CREB in colon （P<0.01）. Compared with the conditions in the model group， the contents of DAO and D-lactic acid in plasma in each administration groups were lower （P<0.01）， while the protein expressions of ZO-1， Occludin， AQP8， AQP4， cAMP， PKA and CREB in colon were higher （P<0.01）. ConclusionShaoyaotang alleviates the diarrhea in UC， probably through activating cAMP/PKA/CREB signaling pathway， up-regulating expressions of AQPs， enhancing tight junctions in intestinal epithelium and thus improving the water metabolism in colon and the intestinal mucosal permeability.
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Shaoyaotang is composed of Cptidis Rhizoma， Scutellariae Radix， Rhei Radix et Rhizoma， Paeoniae Radix Alba， Angelicae Sinensis Radix， Aucklandiae Radix， Arecae Semen， Cinnamomi Cortex and Glycyrrhizae Radix et Rhizoma， with the functions of clearing away heat， eliminating dampness， regulating Qi and activating blood. Thus， it is proposed as the main formula for the treatment of dampness-heat dysentery by later generations of doctors. In modern clinical application， in addition to original Shaoyaotang， its modified formulas are also used for the treatment of ulcerative colitis， and can be used in combination with other prescriptions （such as Tongxie Yaofang， Pulsatilla Soup， Shenling Baizhu San）， western medicine （such as mesalazine， sulfasalazine， Infliximab）， traditional Chinese medicine （TCM） acupuncture or moxibustion and other characteristic therapies. Clinical efficacy results indicate that Shaoyaotang and its modified formulas can significantly lower Mayo Endoscopic Score （MES）， Baron score， TCM syndrome score and other disease scores， and improve patients’ intestinal symptoms， with few side effects. Experimental pharmacological studies reveal that Shaoyaotang can inhibit tumor necrosis factor-α （TNF-α）， nuclear transcription factor-κB （NF-κB）， interleukin-1β （IL-1β） and other pro-inflammatory factors to up regulate the expression of anti-inflammatory factors such as interleukin-10 （IL-10）， thereby reducing the inflammatory response. The formula could also reduce apoptosis by regulating inflammatory signaling pathway and blocking the chain reaction， and repair abnormal immune barrier by balancing immune axis and regulating immune proteins. Additionally， it could adjust the balance of intestinal flora， promote intestinal epithelial cell regeneration and improve mucosal permeability， so as to restore the balance of intestinal environment and thus treat ulcerative colitis. Its monomers baicalin， paeoniflorin， and berberine have anti-inflammatory， antibacterial， metabolism-regulating and other effects. This paper systematically reviewed the clinical and basic research progress of Shaoyaotang in the treatment of ulcerative colitis.
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For the treatment of postherpetic neuralgia, drugs have always played a major but unsatisfactory role. As auxiliary or alternative therapies for postherpetic neuralgia, non-pharmacological interventions, such as electrical stimulation and repetitive transcranial magnetic stimulation, not only have shown favorable efficacy, but also can decrease adverse reactions to drugs with high safety and patient acceptance, and are benificial for management of patients with postherpetic neuralgia.
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We report a case of type A insulin resistance syndrome. A 16-year-old girl with BMI of 19.1 kg/m 2 presented with primary amenorrhea and hyperglycemia for two years. Baseline HbA 1C was 10.8%, along with severe hyperinsulinemia, increased total testosterone and free androgen index(FAI). Ultrasonography showed polycystic ovaries. Next generation sequencing identified a novel and de novo heterozygous missense mutation of Trp1220Gly in the insulin receptor gene. Short-term intensive insulin pump treatment was initiated, followed by insulin glargine, pioglitazone and acarbose combination regiment. Fasting blood glucose and insulin levels decreased significantly, but post-load hyperglycemia and hyperinsulinemia remained unsatisfactory. HbA 1C dropped to 7.6% at 1-year follow up. Patients with polycystic ovarian syndrome who are adolescent-onset and with lean body type should be taken into account of type A insulin resistance syndrome. Currently, there is no standardized treatment protocol, and therapy should be individualized based on the specific gene mutation of each patient.
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Objective:To summarize the clinical and genetic features of 7 patients with a mild form of Geleophysic dysplasia type 2(GD2)/Acromicric dysplasia(AD) induced by fibrillin 1(FBN1) gene mutation from one Chinese family.Methods:A Chinese pedigree of mild GD2/AD treated at the Pediatric Endocrinology Department at the First Affiliated Hospital of Sun Yat-sen University between August 2017 and May 2022 was collected. Whole-exome genetic sequencing of the FBN1 gene were performed to establish the diagnosis. Additionally, a literature review was further conducted.Results:In this family, among 13 individuals spanning three generations, there were 7 affected cases, including 1 adult female, 1 adult male, and 5 children. All individuals exhibited postnatal growth failure, severe disproportionate short stature, and lacked typical facial features. Exome sequencing and Sanger sequencing confirmed the presence of a heterozygous missense mutation c. 5099A>G(p.Tyr1700Cys) in exon 42 of the FBNI gene in 6 affected individuals(Ⅱ-1, Ⅲ-1 to Ⅲ-5), which was identified as a pathogenic mutation. This mutation was previously reported in a Chinese classical achondroplasia(AD) family. Based on comprehensive genetic analysis, clinical features, and multisystem evaluation, 3 cases were diagnosed with mild type 2 growth hormone deficiency(GD2), and 4 cases were diagnosed with mild AD. Recombinant human growth hormone(rhGH; 1.1-1.4 IU·kg -1·week -1) was applied to all the 5 children, and additional gonadotropin releasing hormone analogue(GnRHa) was administered to the 2 girls in late puberty, resulting in certain growth-promoting effect. Conclusions:The c. 5099A>G(p.Tyr1700Cys) mutation not only leads to the classical type of achondroplasia(AD) as reported in the literature but also causes the non-classical GD2 or AD(mild GD2/AD). Further research is warranted to investigate the long-term therapeutic effects of rhGH treatment.
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Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical bacterial isolates from bloodstream infections in China in 2021.Methods:The clinical bacterial strains isolated from blood culture from member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS) were collected during January 2021 to December 2021. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical Laboratory Standards Institute (CLSI). WHONET 5.6 was used to analyze data.Results:During the study period, 11 013 bacterial strains were collected from 51 hospitals, of which 2 782 (25.3%) were Gram-positive bacteria and 8 231 (74.7%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (37.6%), Klebsiella pneumoniae (18.9%), Staphylococcus aureus (9.8%), coagulase-negative Staphylococci (6.3%), Pseudomonas aeruginosa (3.6%), Enterococcus faecium (3.6%), Acinetobacter baumannii (2.8%), Enterococcus faecalis (2.7%), Enterobacter cloacae (2.5%) and Klebsiella spp (2.1%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus aureus were 25.3% and 76.8%, respectively. No glycopeptide- and daptomycin-resistant Staphylococci was detected; more than 95.0% of Staphylococcus aureus were sensitive to ceftobiprole. No vancomycin-resistant Enterococci strains were detected. The rates of extended spectrum B-lactamase (ESBL)-producing isolated in Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis were 49.6%, 25.5% and 39.0%, respectively. The prevalence rates of carbapenem-resistance in Escherichia coli and Klebsiella pneumoniae were 2.2% and 15.8%, respectively; 7.9% of carbapenem-resistant Klebsiella pneumoniae was resistant to ceftazidime/avibactam combination. Ceftobiprole demonstrated excellent activity against non-ESBL-producing Escherichia coli and Klebsiella pneumoniae. Aztreonam/avibactam was highly active against carbapenem-resistant Escherichia coli and Klebsiella pneumoniae. The prevalence rate of carbapenem-resistance in Acinetobacter baumannii was 60.0%, while polymyxin and tigecycline showed good activity against Acinetobacter baumannii (5.5% and 4.5%). The prevalence of carbapenem-resistance in Pseudomonas aeruginosa was 18.9%. Conclusions:The BRICS surveillance results in 2021 shows that the main pathogens of blood stream infection in China are gram-negative bacteria, in which Escherichia coli is the most common. The MRSA incidence shows a further decreasing trend in China and the overall prevalence of vancomycin-resistant Enterococci is low. The prevalence of Carbapenem-resistant Klebsiella pneumoniae is still on a high level, but the trend is downwards.
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Objective:To learn about the condition of Keshan disease at township level in Inner Mongolia Autonomous Region (Inner Mongolia for short).Methods:In accordance with the "Three-Year Tackling Implementation Plan for Keshan Disease in Inner Mongolia", Keshan disease surveillance was carried out from March to December 2019 in the disease affected townships of all 12 diseased banners (counties, cities, disctricts, referred to as banners) in Hulunbuir City, Xing'an League, Chifeng City, and Xilin Gol League in Inner Mongolia, and all permanent residents who lived for more than 6 months were selected as the survey subjects. At the same time, the search for Keshan disease cases was carried out in the relevant medical institutions of the 4 leagues (cities) from 2014 to 2018. The "Diagnosis of Keshan Disease" (WS/T 210-2011) and the "Evaluation Methods for Control and Elimination of Key Endemic Diseases" (2019 edition) were used for diagnosis and elimination evaluation of Keshan disease.Results:There were 75 diseased townships under the jurisdiction of the 12 diseased banners in the 4 leagues (cities) in Inner Mongolia, with a permanent resident population of 1 246 900. A total of 356 150 subjects were examined by electrocardiogram, and 86 507 cases were found to be abnormal, with an abnormal rate of 24.29%. A total of 250 patients with chronic Keshan disease were diagnosed by echocardiography or anteroposterior chest X-ray examination, and the prevalence rate was 2.00/10 000; a total of 287 patients with latent Keshan disease were diagnosed, and the prevalence rate was 2.30/10 000; no patients with acute, subacute or new Keshan disease. After case search, 494 suspected Keshan disease cases were screened out, and 6 cases were finally diagnosed as chronic Keshan disease. From 2014 to 2018, there were no new cases of acute or subacute Keshan disease for five consecutive years, and the prevalence rates of chronic Keshan disease and latent Keshan disease were both lower than 5/10 000 in 2019, meeting the national elimination standard for Keshan disease.Conclusion:In 2019, Inner Mongolia has reached the national elimination standard for Keshan disease, but there are still patients with Keshan disease, so it is necessary to continue to strengthen the monitoring of Keshan disease.
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Background Occupational health risk assessment of dust-exposed operations is an important part of occupational health work. However, there is a lack of objective and effective methods for validating the risk assessment results. Objective To explore the application value of chest imaging changes in validating occupational health risk assessment results of dust-exposed operations. Methods Alumina dust-exposed workers in an abrasive manufacturing company were selected as study subjects. The Australian Occupational Health and Safety Risk Assessment model (Australian model), and the Singapore semi-quantitative risk assessment model of occupational exposure to chemical substances (Singaporean model) were used to conduct occupational health risk assessment for the target group. Consistency of the assessment results was compared. The cumulative risk value and cumulative risk level of the subjects were calculated. The subjects were examined and diagnosed by chest radiographs, and the differences in the positive rates of aluminum dust shadows of workers at different job risk levels and different cumulative risk levels were compared. Results The average risk ratios (RR) of selected alumina dust-exposed workers estimated by the Australian model and the Singapore model were both 0.49±0.10, indicating generally medium occupational health risk level. The evaluation results of the two models were obviously consistent (kappa test, k = 0.823, P < 0.001). Among the 192 subjects, 62 (32.3%) were found to have aluminum dust shadows on their chest radiographs, and there were no case of pneumoconiosis. The aluminum dust shadows were mainly classified by shape and size as “s” (30.7%); the profusion of small opacities was mainly "less than 0/1" (31.3%); they were mostly distributed in 2 pulmonary zones (18.8%), and mostly in the right lower lung (18.8%), and none was seen in the two upper lung zones. The positive rate of aluminum dust shadows in the high-risk workplaces (41.7%) assessed by the Australian model was significantly higher than that in the medium-risk workplaces (22.9%) (P < 0.01). The positive rate of aluminum dust shadows in the medium-risk workplaces (42.7%) assessed by the Singapore model was significantly higher than that in the low-risk workplaces (23.3%) (P < 0.01). The cumulative risk levels evaluated by the two models were all atⅠ- Ⅲ levels. With the increase of cumulative risk level by the two models, the positive rates of aluminum dust shadows in the subjects both showed an obvious increase trend (P < 0.05). Conclusion The risk assessment results of the Australian model and the Singapore model are obviously consistent for the target group. They can be jointly applied to the risk assessment of dust-exposed operations. The application of chest imaging changes is of certain value to validate the results of occupational health risk assessment for dust-exposed operations.
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Objective:To explore the application and effect of multi-level quality control system (referred to as “quality control”) in health management center setting.Methods:The health management center of Hanzhong Central Hospital constructed a multi-level quality control system of “hospital-department-unit” and “department-unit-quality-controller” in August 2019. A total of 83 619 people who underwent physical examination in the Health Management Center of Hanzhong Central Hospital from August 2018 to July 2020 were selected as the subjects. 32 009 people who underwent physical examination from August 2018 to July 2019 were selected as the control group, and 51 610 people who underwent physical examination from August 2019 to July 2020 were selected as the experimental group. The timely notification of important abnormal results and the follow-up of the “four-high” population (hypertension, hyperglycemia, hyperlipidemia, and hyperuricemia) were observed. Two thousand satisfaction questionnaires and two thousand physical examination reports were collected from the institutions who had received both physical examination in the Health Management Center of Hanzhong Central Hospital for two consecutive years. The physical examination items of the above clients were basically the same. The satisfaction rate of the two groups of physical examination and the qualification rate of the physical examination reports were measured respectively.Results:The results showed that the timely notification rate of important abnormal results (99.4% vs 96.6%), follow-up rate of “four-high” population (hypertension 95.1% vs 91.2%, hyperglycemia 95.3% vs 91.6%, hyperlipidemia 94.6% vs 92.3%, hyperuricemia 92.7% vs 86.4%), satisfaction rate of physical examination (physical examination environment 94.0% vs 91.3%, service attitude 96.4% vs 91.9%, waiting time 97.6% vs 95.4%, physical examination process 98.3% vs 96.8%, professional level of medical staff 97.2% vs 95.1%), and qualified rate of physical examination report (accuracy of input information 99.5% vs 98.1%, accuracy of main examination conclusion 99.4% vs 97.3%, normative sorting 99.8% vs 98.8%, rationality of health advice 99.2% vs 96.8%) in the experimental group were significantly higher than those in the control group (all P<0.05). Conclusion:The establishment of a multi-level quality control system in health examination service can improve the timely notification rate of important abnormal results, the follow-up rate of the “four-high” population, the satisfaction of physical examinees, and the qualified rate of physical examination reports.
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The rapid development of Internet, big data, artificial intelligence and information technology and their integration with medicine have given birth to a new model and direction of modern medical development. The health of the people′s livelihood has become an indispensable part of the national health care system development. At the same time, China′s medical resources are relatively scarce and the population aging trend is obvious, which has a more prominent contradiction with the people′s growing demand for diagnosis and treatment services and medical humanities. In the context of building a healthy China, it has become an inevitable trend to apply intelligent medicine to the construction of medical humanities. This paper summarizes the current situation of intelligent medical treatment and medical humanities in China, the application of intelligent medical treatment in medical humanities construction, and the possible challenges in the intelligent process of medical humanities construction, and discusses the impact of intelligent medical treatment on the development of medical humanities construction.
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Early childhood caries (ECC) is a significant chronic disease of childhood and a rising public health burden worldwide. ECC may cause a higher risk of new caries lesions in both primary and permanent dentition, affecting lifelong oral health. The occurrence of ECC has been closely related to the core microbiome change in the oral cavity, which may be influenced by diet habits, oral health management, fluoride use, and dental manipulations. So, it is essential to improve parental oral health and awareness of health care, to establish a dental home at the early stage of childhood, and make an individualized caries management plan. Dental interventions according to the minimally invasive concept should be carried out to treat dental caries. This expert consensus mainly discusses the etiology of ECC, caries-risk assessment of children, prevention and treatment plan of ECC, aiming to achieve lifelong oral health.
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Child , Child, Preschool , Humans , Consensus , Dental Caries/prevention & control , Dental Caries Susceptibility , Oral HealthABSTRACT
Objective:To study the effect of water improvement on urinary arsenic methylation metabolism in population exposed to arsenic through drinking water.Methods:A cluster sampling method was used to select drinking water type arsenism areas in Bayannur City, Inner Mongolia Autonomous Region. Permanent residents lived in the arsenism areas for more than 10 years were selected as the survey subjects. Urine samples ( n = 874, 111, 145) were collected in 2004 (before water improvement), 2014 (4 years after water improvement) and 2017 (7 years after water improvement), respectively, and some subjects were followed up in 2014 and 2017. High performance liquid chromatography-inductively coupled plasma mass spectrometry (HPLC-ICP-MS) was used to detect different forms of arsenic metabolites in urine [inorganic arsenic (iAs), monomethylarsonic acid (MMA), dimethylarsenic acid (DMA)], and total arsenic (tAs), the iAs percentage (iAs%), MMA percentage (MMA%), DMA percentage (DMA%), monomethylation rate (PMI), dimethylation rate (SMI), and the ratio of MMA to DMA (MMA/DMA) were calculated. The content and distribution of urinary arsenic metabolites in people exposed to arsenic before and after water improvement were compared and analyzed. Results:Compared with 2004, the levels of iAs, MMA, DMA, tAs and iAs% in urine of arsenic exposed population in 2014 were lower ( Z =-14.12,-12.79,-14.27,-14.21,-6.90, P < 0.001), the levels of MMA%, DMA% and PMI were higher ( Z =-3.22,-2.91,-6.90, P < 0.05); in the same drinking water arsenic exposed population, compared with 2004, the levels of iAs, MMA, DMA, tAs and iAs% in urine ( n = 48) were lower ( Z =-5.57,-5.53,-5.54,-5.55,-2.86, P < 0.05) in 2014, and PMI level was higher ( Z =-2.86, P = 0.004). Compared with 2014, the levels of iAs% and MMA/DMA in urine of arsenic exposed population in 2017 were lower ( Z =-4.97,-2.25, P < 0.05), the levels of MMA, DMA, tAs, DMA%, PMI and SMI were higher ( Z =-4.01,-5.39,-4.77,-4.61,-4.97,-2.25, P < 0.05); in the same drinking water arsenic exposed population, compared with 2014, the level of iAs% in urine ( n = 28) was lower ( Z =-2.87, P = 0.004) in 2017, the levels of DMA% and PMI were higher ( Z =-2.32,-2.87, P < 0.05). Conclusion:Water improvement could significantly reduce the levels of urinary arsenic metabolites iAs, MMA, DMA and tAs and increase the level of DMA% in arsenic exposed population.
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Dental Caries is a kind of chronic oral disease that greatly threaten human being's health. Though dentists and researchers struggled for decades to combat this oral disease, the incidence and prevalence of dental caries remain quite high. Therefore, improving the disease management is a key issue for the whole population and life cycle management of dental caries. So clinical difficulty assessment system of caries prevention and management is established based on dental caries diagnosis and classification. Dentists should perform oral examination and establish dental records at each visit. When treatment plan is made on the base of caries risk assessment and carious lesion activity, we need to work out patient‑centered and personalized treatment planning to regain oral microecological balance, to control caries progression and to restore the structure and function of the carious teeth. And the follow-up visits are made based on personalized caries management. This expert consensus mainly discusses caries risk assessment, caries treatment difficulty assessment and dental caries treatment plan, which are the most important parts of caries management in the whole life cycle.
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Humans , Consensus , Dental Care , Dental Caries/prevention & control , PrevalenceABSTRACT
Objective:To investigate the bacterial composition and antimicrobial resistance profile of clinical isolates from bloodstream infections in China.Methods:The clinical bacterial strains isolated from blood culture were collected during January 2020 to December 2020 in member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS). Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical Laboratory Standards Institute(CLSI, USA). WHONET 5.6 was used to analyze data.Results:During the study period, 10 043 bacterial strains were collected from 54 hospitals, of which 2 664 (26.5%) were Gram-positive bacteria and 7 379 (73.5%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (38.6%), Klebsiella pneumoniae (18.4%), Staphylococcus aureus (9.9%), coagulase-negative Staphylococci (7.5%), Pseudomonas aeruginosa (3.9%), Enterococcus faecium (3.3%), Enterobacter cloacae (2.8%), Enterococcus faecalis (2.6%), Acinetobacter baumannii (2.4%) and Klebsiella spp (1.8%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus aureus were 27.6% and 74.4%, respectively. No glycopeptide- and daptomycin-resistant Staphylococci were detected. More than 95% of Staphylococcus aureus were sensitive to rifampicin and SMZco. No vancomycin-resistant Enterococci strains were detected. Extended spectrum β-lactamase (ESBL) producing Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis were 48.4%, 23.6% and 36.1%, respectively. The prevalence rates of carbapenem-resistance in Escherichia coli and Klebsiella pneumoniae were 2.3% and 16.1%, respectively; 9.6% of carbapenem-resistant Klebsiella pneumoniae strains were resistant to ceftazidime/avibactam combination. The prevalence rate of carbapenem-resistance in Acinetobacter baumannii was 60.0%, while polymyxin and tigecycline showed good activity against Acinetobacter baumannii. The prevalence rate of carbapenem-resistance of Pseudomonas aeruginosa was 23.2%. Conclusions:The surveillance results in 2020 showed that the main pathogens of bloodstream infection in China were gram-negative bacteria, while Escherichia coli was the most common pathogen, and ESBL-producing strains declined while carbapenem-resistant Klebsiella pneumoniae kept on high level. The proportion and the prevalence of carbapenem-resistant Pseudomonas aeruginosa were on the rise slowly. On the other side, the MRSA incidence got lower in China, while the overall prevalence of vancomycin-resistant Enterococci was low.
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Objective:To investigate the distribution and antimicrobial resistance profile of clinical bacteria isolated from blood culture in China.Methods:The clinical bacterial strains isolated from blood culture from member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS) were collected during January 2018 to December 2019. Antibiotic susceptibility tests were conducted with agar dilution or broth dilution methods recommended by US Clinical and Laboratory Standards Institute (CLSI). WHONET 5.6 was used to analyze data.Results:During the study period, 14 778 bacterial strains were collected from 50 hospitals, of which 4 117 (27.9%) were Gram-positive bacteria and 10 661(72.1%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (37.2%), Klebsiella pneumoniae (17.0%), Staphylococcus aureus (9.7%), coagulase-negative Staphylococci (8.7%), Pseudomonas aeruginosa (3.7%), Enterococcus faecium (3.4%), Acinetobacter baumannii(3.4%), Enterobacter cloacae (2.9%), Streptococci(2.8%) and Enterococcus faecalis (2.3%). The the prevalence of methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus were 27.4% (394/1 438) and 70.4% (905/1 285), respectively. No glycopeptide-resistant Staphylococcus was detected. More than 95% of S. aureus were sensitive to amikacin, rifampicin and SMZco. The resistance rate of E. faecium to vancomycin was 0.4% (2/504), and no vancomycin-resistant E. faecalis was detected. The ESBLs-producing rates in no carbapenem-resistance E. coli, carbapenem sensitive K. pneumoniae and Proteus were 50.4% (2 731/5 415), 24.6% (493/2001) and 35.2% (31/88), respectively. The prevalence of carbapenem-resistance in E. coli and K. pneumoniae were 1.5% (85/5 500), 20.6% (518/2 519), respectively. 8.3% (27/325) of carbapenem-resistance K. pneumoniae was resistant to ceftazidime/avibactam combination. The resistance rates of A. baumannii to polymyxin and tigecycline were 2.8% (14/501) and 3.4% (17/501) respectively, and that of P. aeruginosa to carbapenem were 18.9% (103/546). Conclusions:The surveillance results from 2018 to 2019 showed that the main pathogens of bloodstream infection in China were gram-negative bacteria, while E. coli was the most common pathogen, and ESBLs-producing strains were in majority; the MRSA incidence is getting lower in China; carbapenem-resistant E. coli keeps at a low level, while carbapenem-resistant K. pneumoniae is on the rise obviously.
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Objective:To investigate the distribution of arsenic content in drinking water of residents in Inner Mongolia Autonomous Region, and to provide a scientific basis for formulation of detailed prevention and control measures for endemic arsenic poisoning.Methods:From 2017 to 2019, water arsenic survey was carried out in all natural villages in 103 banners (counties, districts) of 12 leagues (cities) in Inner Mongolia Autonomous Region, and drinking water samples were collected according to different water supply modes (engineering water supply, physical and chemical water purification, decentralized water supply). Among them, engineering water supply: one factory water sample was collected from each water modification project in dry season and wet season; and one terminal water sample was collected in historical arsenism area/high arsenic exposed villages covered by the project. Physical and chemical water purification: one water sample was collected from each household. Decentralized water supply: in historical arsenism area/high arsenic exposed villages, one water sample was collected from each household; in the villages with historical qualified water arsenic, one household was selected according to the five directions of east, south, west, north and middle, and one water sample was collected from each household. The content of arsenic in water was detected by atomic fluorescence spectrometry and a distribution map of water samples with excessive arsenic was drawn using ArcGIS 10.2 software.Results:A total of 90 455 water samples were collected, including 31 617 water samples for engineering water supply, 2 702 water samples for physical and chemical water purification, and 56 136 water samples for decentralized water supply. The medians of water arsenic content of engineering water supply, physical and chemical water purification, and decentralized water supply were 1.00, 1.00 and 0.50 μg/L, respectively, and the differences among different water supply modes were statistically significant (χ 2 = 1 147.831, P < 0.05). A total of 486 water samples with excessive arsenic were detected, the detection rate was 0.54% (486/90 455). The detection rates of water samples with excessive arsenic in engineering water supply and decentralized water supply were 1.48% (469/31 617) and 0.03% (17/56 136), the detection rate of water samples with excessive arsenic in engineering water supply was higher than that in decentralized water supply (χ 2 = 775.401, P < 0.05); there was no water samples with excessive arsenic in physical and chemical water purification. The top three areas with the detection rates of water samples with excessive arsenic were Bayannaoer [15.38% (343/2 230)], Hohhot [2.00% (86/4 293)], and Ordos [0.85% (50/5 848)]. ArcGIS 10.2 software showed that the water samples with excessive arsenic were mainly distributed in the western region in the shape of focal and block, and only existed sporadically in the eastern region. Conclusions:The detection rate of water samples with excessive arsenic in engineering water supply in Inner Mongolia Autonomous Region is high, the water samples with excessive arsenic are mainly distributed in the western region in the shape of focal and block, and sporadically in the eastern region. The management and supervision of engineering water supply should be strengthened, in areas where the water arsenic exceeds the standard, we should take physical and chemical water purification measures, such as change water sources, increase water purification equipment, and improve water purification technology to reduce arsenic hazards, so as to ensure that residents can drink qualified water.
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Objective:To investigate the levels of urinary arsenic metabolites in arsenic-exposed people with different degrees of skin lesions.Methods:A cluster sampling method was used to select people with different degrees of skin lesions in the drinking water arsenic poisoning area of Bayannaoer City, Inner Mongolia Autonomous Region. According to the "Standard of Diagnosis for Endemic Arsenism" (WS/T 211-2001), the research subjects were divided into four clinical grading: normal, suspicious, mild, moderate and above on the basis of the degrees of skin lesions. Urine samples from any 1 middle section were collected, and the levels of urinary arsenic metabolites of different forms in different clinically graded people were detected by inductively coupled plasma mass spectrometry (ICP-MS).Results:A total of 522 people were included, including 309 males and 213 females; the age was (39.11 ± 12.38) years old, ranging from 11 to 65 years old. There were 337, 80, 31, 74 people in normal, suspicious, mild, moderate and above clinical grading, the levels of inorganic arsenic (iAs, medians: 15.46, 37.16, 104.46, 163.06 μg/L), monomethylarsonic acid (MMA, medians: 15.95, 33.27, 82.80, 123.84 μg/L), dimethylarsenic acid (DMA, medians: 78.16, 147.86, 301.28, 371.30 μg/L), total arsenic (tAs, medians: 113.90, 220.94, 501.25, 684.46 μg/L), iAs percentage (iAs%, medians: 15.66%, 15.53%, 21.67%, 21.65%), MMA percentage (MMA%, medians: 13.51%, 15.40%, 17.14%, 16.43%), DMA percentage (DMA%, medians: 70.37%, 67.98%, 63.25%, 61.23%), monomethylation rate (PMI, medians: 0.84, 0.84, 0.78, 0.78), dimethylation rate (SMI, medians: 0.84, 0.81, 0.79, 0.79), and ratio of MMA to DMA (MMA/DMA, medians: 0.20, 0.23, 0.27, 0.27) were compared in different clinically graded people, the differences were statistically significant ( H = 97.98, 96.44, 85.50, 95.08, 38.58, 29.94, 51.98, 38.58, 43.20, 43.20, P < 0.01). Compared with normal people, iAs, MMA, DMA, tAs, MMA%, and MMA/DMA levels significantly increased, and SMI level significantly decreased in suspicious, mild, moderate and above people ( P < 0.017); compared with normal people, iAs% level significantly increased, and DMA% and PMI levels significantly decreased in mild, moderate and above people ( P < 0.017). Conclusion:The levels of urinary arsenic metabolites in arsenic-exposed people with different degrees of skin lesions are different, showing a dose-response relationship.
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Objective:To investigate the prevalence of residents in a drinking water-borne endemic arsenism area in Togtoh County Inner Mongolia.Methods:In a drinking water-borne endemic arsenism area (Togtoh County of Inner Mongolia), eighty-five permanent residents (residence time ≥20 years) of Hedgehog Valley were selected as exposure group. In the same period, 58 people from a non-arsenism area (Lanjiayao of Helingeer County) were selected as the control group. The general situation of the respondents was investigated, and water arsenic, urine arsenic, blood glucose, blood lipids, blood pressure, liver function, renal function, electrocardiogram and abdominal B-ultrasound were analyzed in both groups. The exposure group was divided into the disease group and the non-disease group according to whether arsenic poisoning skin lesions occurred, and the general conditions and blood pressure changes in the two groups were analyzed.Results:In the exposure group and control group, there were no significant differences among the indicators such as sex, age, smoking, drinking and taking vitamin or calcium tablet ( P > 0.05). Arsenic concentration [Median (interquartile range)] in drinking water of the exposure group was 163.34 (35.34) μg/L, and in urine was 269.72 (152.54) μg/L. Arsenic concentration in drinking water of the control group was 2.96 (5.62) μg/L, and in urine was 24.21 (28.63) μg/L. There were no statistical differences in blood glucose, blood lipids between the exposure group and control group (χ 2 = 0.865, 0.886, P > 0.05); but liver function, renal function, sinus arrhythmia and fatty liver were significantly different statistically (χ 2 = 4.654, 4.355, 4.725, 12.423, P < 0.05); the detection rate of abnormal blood pressure in control group was higher than that of the exposure group (χ 2 = 16.289, P < 0.01). Skin lesions occurred in 24 patients (28.24%) in the exposure group and no skin lesions in 61 patients (71.76%). In disease group, 14 cases (58.33%, 14/24) smoked, the proportion of smoking was higher than that of cases in non-disease group(31.15%, 19/61, χ 2 = 5.360, P < 0.05); and the prevalence of hypertension (50.00%, 12/24) in cases of disease group was higher than that of cases in non-disease group (26.23%, 16/61, χ 2 = 4.406, P < 0.05). Conclusions:Long-term exposure to arsenic might injure liver function and renal function, and enhance the risk of arrhythmia and fatty liver. Smoking may be a risk factor for skin lesions in residents of drinking water-borne endemic arsenism area.
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Objective:To explore the effect of peer instruction in pediatrics lab class.Methods:Two classes in the fourth year of undergraduate clinical medicine major in Xinjiang Medical University were randomly selected as the experimental class ( n=50) and the control class ( n=51). The experimental class was taught by peer instruction, and the students in this class were randomized into teaching students ( n= 16) and taught students ( n=34); the control class was educated by traditional teaching and the teaching content was in line with the syllabus of pediatrics. The effect of peer instruction was evaluated by comparing the results of the pediatric final exams in the experimental class and the control class through t test of these two independent samples. At the same time, the impact of peer instruction on students' teaching ability, learning effect of the professional knowledge, personal quality, and future career development was evaluated by questionnaires. Results:The average score of the pediatric final exam in the experimental class (82.97±2.59) was significantly higher than that in the control class (79.22±8.84) ( P<0.05). The results of the questionnaires showed that most of the teaching and taught students considered that peer instruction could promote the improvement of students' teaching ability, learning effect of the professional knowledge and personal quality. Conclusion:Peer instruction improves the teaching effect of pediatrics lab class, and is conducive to the improvement of the basic teaching ability and personal quality of clinical medical students, which is worth of application in clinical medicine teaching.