Analysis of typing conversion and perinatal outcomes in twins with selective intrauterine growth restriction of different subtypes / 中华妇产科杂志

Objective: To retrospectively analyze the clinical data of different types of selective intrauterine growth restriction (sIUGR) pregnant women under expectant management, including the natural evolution, typing conversion and perinatal outcomes. Methods: The clinical data of 153 pregnant women with sIUGR under expected treatment in Women's Hospital, Zhejiang University School of Medicine from January 2014 to December 2018 were collected. Maternal characteristics including maternal age, gravidity, parity, method of conception, pregnancy complication, gestational age at delivery, indication for delivery, birth weight, the rate of intrauterine and neonatal death and neonatal outcomes were recorded. Pregnant women with sIUGR were divided into three types according to end-diastolic umbilical artery flow Doppler ultrasonography, and the differences of typing conversion and perinatal outcomes of sIUGR pregnant women based on the first diagnosis were compared. Results: (1) Clinical characteristics and pregnancy outcomes: among 153 pregnant women with sIUGR, 100 cases (65.3%) were diagnosed with type Ⅰ, 35 cases (22.9%) with type Ⅱ, and 18 cases (11.8%) with type Ⅲ. There were no significant differences in age, conception mode, pregnancy complications, first diagnosis gestational age, characteristics of umbilical cord insertion, delivery indications, fetal intrauterine mortality and neonatal mortality among three types of sIUGR pregnant women (all P>0.05). The average gestational age at delivery of type Ⅰ sIUGR was (33.5±1.9) weeks, which was significantly later than those of type Ⅱ and Ⅲ [(31.3±1.8), (31.2±1.1) weeks, P<0.001]. The percentage disordance in estimated fetal weight (EFW) of type Ⅰ sIUGR was significantly lower than those of type Ⅱ and type Ⅲ (P<0.001). The incidence rate of neonatal intensive care unit (NICU) admission, cerebral leukomalacia and respiratory complications of both fetus and necrotizing enterocolitis of large fetus in type Ⅰ were significantly lower than those in type Ⅱ and type Ⅲ (all P<0.05). (2) Typing conversion: in 100 cases of type Ⅰ sIUGR, 18 cases progressed to type Ⅱ and 10 cases progressed to type Ⅲ. Compared with 72 stable type Ⅰ sIUGR, those with progressed type Ⅰ sIUGR had higher incidence of NICU admission and lung disease in both fetuses, and cerebral leukomalacia and necrotizing enterocolitis in large fetus (all P<0.05). The proportion of inconsistent cord insertion was significantly higher in those type Ⅰ progressed to type Ⅲ (6/10) than in those with stable type Ⅰ (19.4%, 14/72) and type Ⅰ progressed to type Ⅱ sIUGR [0 (0/18), P=0.001]. Four cases of type Ⅱ sIUGR reversed to type Ⅰ and 6 cases reversed to type Ⅲ. Compared with type Ⅱ reversed to type Ⅰ sIUGR, those stable type Ⅱ and type Ⅱ reversed to type Ⅲ sIUGR had a higher incidence of NICU admission in large fetus (P<0.05). Two cases of type Ⅲ sIUGR reversed to type Ⅰ and 6 cases progressed to type Ⅱ. There were no significant differences in fetal serious complications in type Ⅲ sIUGR with or without doppler changes (all P>0.05). Conclusions: The different types of sIUGR could convert to each other. The frequency of ultrasound examinations should be increased for patients with the type Ⅰ sIUGR, especially when the percentage discordance in EFW is substantial or with discordant cord insersion.

Analysis of molecular and clinical characteristics of carbapenem-resistant hypervirulent Klebsiella pneumoniae in the intensive care unit / 中华预防医学杂志

To investigate the carbapenemases distribution of carbapenem-resistant Klebsiella pneumoniae (CRKP) in the intensive care unit, and the clinical characteristics between carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) and carbapenem-resistant non-hypervirulent Klebsiella pneumoniae (CR-non-hvKP) were compared. A total of 53 non-repetitive CRKP strains isolated from 49 patients in the intensive care unit of the Second Affiliated Hospital of Xi'an Jiaotong University from May 2020 to March 2021 were retrospectively studied. The carbapenemase inhibitor enhancement test was used for screening carbapenemase-producing strains, and the string test was carried out to screen the hypermucoviscosity phenotype. Using PCR to detect five main carbapenemase genes (blaKPC-2, blaNDM, blaIMP , blaVIM and blaOXA-48-like), common serotype (K1 and K2) and virulence gene (rmpA and iutA). Treated the strains with both rmpA and iutA genes as hypervirulent Klebsiella pneumonia (hvKP), and the whole genome sequencing of CR-hvKP was completed. At the same time, the clinical data of 49 patients were sorted out, and the differences in clinical characteristics of CR-hvKP and CR-non-hvKP infected patients were compared using the independent sample t test, Mann-Whitney U test, chi-square test or Fisher's exact probability test. CRKP isolated from the intensive care unit were extensively drug resistance and still had a good sensitivity to polymyxin B and tigecycline. Producing carbapenemases were the main resistance mechanism of CRKP (52/53, 98.1%). Of the 53 CRKP strains, except for 1strain that did not detect carbapenemase, at least one carbapenemase resistance gene was detected in the remaining 52 CRKP strains, of which 45 strains carried an enzyme, including 36 blaKPC-2 (36/53, 67.9%), 8 blaNDM (8/53, 15.1%), 1 blaIMP (1/53, 1.9%), and 7 strains carried with both blaKPC-2 and blaNDM (7/53, 13.2%). String test and virulence gene showed that 7 CR-hvKP strains (13.2%) were detected in 53 CRKP strains, and two of which were hypermucoviscosity phenotype. Sequencing results revealed that CR-hvKP were mainly ST11 type. Almost all patients with CR-hvKP infection were over 60 years old (7/7), with invasive treatment (7/7), pulmonary infection with hypermucoviscosity phenotype (2/7) and high mortality (5/7); and the percentage of neutrophils in patients with CR-hvKP infection (86.44±4.70) % was higher than those patients with CR-non-hvKP infection (78.90±19.15) %, the difference was statistically significant (t=-2.225, P=0.032). The CR-hvKP strains in the intensive care unit mainly produced KPC-2 enzyme, with K2 capsular serotype and ST11 type. It is necessary to strengthen the monitoring and control of the CR-hvKP strain to prevent the co-evolution of drug-resistant and hypervirulent strains.

Therapeutic effects of extract of Albizia chinensis(Osbeck)Merr. on rats with acetic acid-induced chronic gastric ulcer and anti-inflammatory mechanism / 国际药学研究杂志

Objective To investigate the anti-ulcer effects of Albizia chinensis(Osbeck)Merr. extract on rats with acetic acid-induced chronic gastric ulcer and explore the anti-inflammatory mechanism. Methods Wistar male rats(n=50)were randomized in-to five groups:control,model,famotidine,Albizia chinensis extract 100 and 200 mg/kg groups. In the experiment,30%acetic acid was used to induce chronic gastric ulcer in rats. The anti-ulcer effects of A. chinensis extract were evaluated by measuring the changes in general behavior of rats,gastric tissue morphology and the ulcer area after 12 d treatments. Wistar male rats(n=48)were random-ized into three groups:control,model and A. chinensis extract(200 mg/kg)groups. At 3 d after operation,the animals were sacrificed and stomachs were rapidly removed and processed for subsequent assays. The contents of TNF-αand IL-6 were evaluated by ELISA. The activity of myeloperoxidase(MPO)was tested by o-dianisidine method. Furthermore Western blot was used to examine the phos-phorylation of P38 and JNK. Results Compared with the model group,the gastric ulcer areas of rats were reduced by 38.4%(P<0.05)and the activity of MPO declined by 37.3%(P<0.01)in A. chinensis extract(200 mg/kg)group. Meanwhile the contents of TNF-αand IL-6 in A. chinensis extract(200 mg/kg)group respectively decreased by 43.8%(P<0.01)and 32.7%(P<0.01)com-pared with the model group. A. chinensis extract(200 mg/kg)obviously suppresed the phosphorylation of P38(P<0.01),but phos-phorylation of JNK and expression of P38 and JNK remained nearly unaltered. Conclusion A. chinensis extract(200 mg/kg)exhibits a protective effect on acetic acid-induced chronic gastric ulcer,which might be relevant to anti-inflammation by inhibiting the p38 sig-naling pathway but not JNK signaling pathway. A. chinensis extract(200 mg/kg)has no effect on JNK signaling pathway.

Effect and possible mechanism of Albizia chinensis extract on gastric ulcer in rats / 国际药学研究杂志

Objective To investigate the gastric protective effect of Albizia chinensis extract on acute gastric ulcer model in rats and its mechanism related to H+,K+-ATPase in gastric parietal cells. Methods Rats were injected intraperitoneally with indo?metacin or kept under water immersion-restraint stress(WRS)to establish acute gastric ulcer model. Test samples were orally given 30 min before induction of gastric ulcer,and the gastric ulcer index and inhibitory rate were used to evaluate the effect of A. chinensis extract. Gastric mucosa pathological tissues in rats were observed by HE staining,the enzymatic activity of proton pump on isolated gastric parietal cells was measured,and the translocation of gastric proton pump was observed by immunofluorescence cell staining. Results The A. chinensis extract inhibited the gastric ulcer with the inhibition rate of 70.0%and 75.4%at 300 mg/kg in the WRS and indomethacin-induced rat model,respectively. The extract could also inhibit the enzymatic activity of gastric proton pump with the in?hibition rate of 21.5%,29.4%,44.1%,51.9%,57.7%and 62.9%(P<0.01)at 15,30,60,120 and 480 mg/L,respectively. The half-effective dosage(ID50)of the extract was determined to be 130 mg/L. The extract showed no significant effect on the translocation of gastric proton pump. Conclusion The A. chinensis extract(300 mg/kg,ig)could significantly prevent the formation of gastric ul?cer in rats via inhibiting the enzymatic activity of gastric proton pump.