Research progress on drug resistance mechanism and treatment of Stenotrophomonas maltophilia / 中华临床感染病杂志

Stenotrophomonas maltophilia is a gram-negative bacillus which widely exists in natural and hospital environment, and it is also one of the common opportunistic pathogens in clinical settings. The virulence and pathogenicity of Stenotrophomonas maltophilia are weak, however, due to resistance to a variety of antibacterial drugs, it can cause bloodstream infections or pneumonia in immunocompromised or critically ill patients, leading to poor prognosis. Moreover, the inherent drug resistance and increasing acquired drug resistance may make the treatment of the first line antibiotics, like trimethoprim-sulfamethoxazole or quinolone ineffective. Therefore, it is important to understand the drug resistance mechanism and the main countermeasures for it. In this article, the research progress on drug resistance mechanism and treatment for Stenotrophomonas maltophilia are reviewed.

Coronavirus disease 2019 in pregnancy.

OBJECTIVES: This study aimed to compare clinical courses and outcomes between pregnant and reproductive-aged non-pregnant women with COVID-19, and to assess the vertical transmission potential of COVID-19 in pregnancy. METHODS: Medical records of pregnant and reproductive-aged non-pregnant women hospitalized with COVID-19 from January 15 to March 15, 2020 were retrospectively reviewed. The severity of disease, virus clearance time, and length of hospital stay were measured as the primary objective, while the vertical transmission potential of COVID-19 was also assessed. RESULTS: Eighty-two patients (28 pregnant women, 54 reproductive-aged non-pregnant women) with laboratory-confirmed COVID-19 were enrolled in this study. Univariate regression indicated no association between pregnancy and severity of disease (OR 0.73, 95% CI 0.08-5.15; p=0.76), virus clearance time (HR 1.16, 95% CI 0.65-2.01; p=0.62), and length of hospital stay (HR 1.10, 95% CI 0.66-1.84; p=0.71). Of the pregnant women, 22 delivered 23 live births, either by cesarean section (17, 60.7%) or vaginal delivery (5, 17.9%), and no neonate was infected with SARS-CoV-2. CONCLUSIONS: Pregnant women have comparable clinical courses and outcomes with reproductive-aged non-pregnant women when infected with SARS-CoV-2. No evidence supported vertical transmission of COVID-19 in the late stage of pregnancy, including vaginal delivery.

Eosinopenia Phenotype in Patients with Coronavirus Disease 2019: A Multi-center Retrospective Study from Anhui, China

BackgroundCoronavirus disease 19 (COVID-19) has become a global unprecedented pandemic infecting more than one millon people, which is declared by WHO as a international public health emergency. Eosinopenia may predict a poor prognosis of COVID-19. However, to date, there is no detailed analysis of the clinical characteristics of COVID-19 patients with eosinopenia. Research questionThe aim of this study was to describe clinical characteristics of COVID-19 patients with eosinopenia. Study Design and MethodsThis was a multi-center retrospective study conducted in three tertiary hospitals. A total of 59 patients with COVID-19 were reviewed from January 23, 2020 to March 10, 2020. We described clincial characteristics of patients with COIVD-19 and eosinopenia phenotype. ResultsThe median age of patients with COVID-19 was 39 years old, and 32 (54,2%) were male. Patients with severe type had higher proportions of dyspnea (50%) and gastrointestinal symptoms (50%) compared with mild or moderate patients. Laboratory findings indicated that lower counts of lymphocyte and eosnophils were observed in patients with severe type. Cough, sputum, and fatigue were more common symptoms in eosinopenia patients compared with non-eosinopenia patients. High proportion of comorbidities was observed in eosinopenia patients. Laboratory findings indicated that lymphocyte counts (median: 101 cells/l) in eosinopenia patients were significantly less than those of non-eosinopenia patients (median: 167 cells/l, p<0.001). The use of corticosteroids therapy in COVID-19 patients with eosinopenia were notably higher than those in patients with non-eosinopenia (50% vs 13.8%, respectively, p=0.005). Compared with parameters in non-eosinopenia patients, eosinopenia patients were more inclined to have less lymphocyte counts (OR value 6.566, 95%CI[1.101-39.173], p=0.039). InterpretationEosinopenia are very common in COVID-19 patient, particularly in severe patients. Common symptoms included fever, cough, sputum, and fatigue are frequent in eosinopenia patients. Eosinopenia may represent a novel phenotype in COVID-19, which needs further investigation.

Transcranial direct current stimulation reconstructs diminished thalamocortical connectivity during prolonged resting wakefulness: a resting-state fMRI pilot study.

Reductions in the alertness and information processing capacity of individuals due to sleep deprivation (SD) were previously thought to be related to dysfunction of the thalamocortical network. Previous studies have shown that transcranial direct current stimulation (tDCS) can restore vigilance and information processing after SD. However, the underlying neural mechanisms of this phenomenon remain unclear. The purpose of this study was to investigate the neurocognitive mechanisms of tDCS following SD, by comparing changes in the brain network, especially the thalamocortical network, after tDCS and sham stimulation following 24 h of SD. Sixteen healthy volunteers were tested in a sham-controlled, randomized crossover design experiment. Resting-state functional magnetic resonance imaging was conducted during resting wakefulness and again after either active tDCS or sham stimulation to the right dorsolateral prefrontal cortex (1.0 mA, 20 min) immediately following 24 h of SD. Seed-based correlations and graph theory analysis were used to determine functional connectivity within the brain thalamocortical network. When tDCS was used, the functional connectivity of the thalamus with the temporal lobe and left caudate was higher than that when the sham stimulation was used. Analysis using graph theory showed that compared with sham stimulation, tDCS administration was associated with a significant improvement in not only the number of connections but also the global efficiency of the thalamus itself. Our study reveals a modulation of the activity of the intrinsic thalamus networks after tDCS. The effects may help explain earlier reports of improvements in the cognitive performance after anodal-tDCS.

Research on the application of Net Present Value method in medical equipment procurement / 中国医学装备

Objective:To strengthen the management and improve the efficiency of medical equipment purchasing, promote the growth of hospital equipment resource value, find scientific equipment procurement ways and methods, establish standardized procurement mode, strive to the code of conduct for the extensive experience into the scientific method of procurement. Methods: Using Net Present Value(NPV) method in financial management on medical equipment purchasing economic benefit analysis, and combined with specific cases and data to analyze the procurement of medical equipment suppliers to provide the equipment procurement scheme.Results: On the assumption that the cost of capital rate is 10%, the three schemes are according to the straight line depreciation method, scheme a net present value for 6.96625 million yuan; scheme 2 net present value for 1.061918 million yuan; project net present value of 5.74608 million yuan; scheme 2 net present value, the second scheme, the net present value of the maximum. Net present value method is an important guarantee for hospital equipment purchase and scientific investment and improved management. Conclusion: Application of net present value method in the purchase of medical equipment show that in equipment procurement program diversification, multiple choice, with net present value method were quantified in order to provide the basis for decision-making, the use of net present value method and the traditional procurement scheme option compared to standards and the scientific nature of medical equipment procurement management, accuracy and objectivity of data analysis.

Research on application of cost benefit analysis in medical equipment management / 中国医学装备

Objective:Using scientific methods, data analysis, improve the ability and level of medical equipment management.Methods: Using the investment return method, the payback period method and the guaranteed business method, the cost benefit analysis of medical equipment is carried out with the actual case(PET/CT).Results: Worked out according to the formula, the equipment in the operation for six years, the investment return rate reaches the highest 58.03%, 3 years basically to recover investment costs, annual check touchdowns 581 cases can achieve guaranteed business income 7558699.61 yuan(RMB).Conclusion: Through the cost-benefit analysis, it can track the benefits of the existing medical equipment, and can also estimate the benefits of the proposed medical equipment, and provide the decision-making basis for the hospital management.

Exploration on the purchasing mode of hospital equipment / 中国医学装备

Objective:Through the discussion on the purchasing mode of hospital equipment in China, fully understand the advantages and disadvantages of various procurement ways, choose reasonable acquisition method, optimize acquisition method, standardize the procurement management objective.Methods: By using the method of analogy, comparison of the four main acquisition methods. By the comparative analysis, the scope of each purchase way was confirmed. Results: Public bidding was better for more than 500000 yuan or the treasury payment items, competitive negotiation approach applies to 50000 yuan-500000 yuan purchase project. Consultation approach can be applied to 50000 yuan purchase project. Information project procurement preferred to methods of government procurement.Conclusion: Reasonable choices of purchasing and proper optimization has significant meaning for equipment purchasing and management in hospital.

Research on the application of Fuzzy synthesis in medical equipment procurement bidding / 中国医学装备

Objective:To discuss and set up indicator system of medical equipment procurement bidding, propose the evaluation methods which based on Fuzzy synthesis and confirm the most appropriate bidder for improving the management level of hospital in medical equipment purchase. Methods: From the bidder's ability to compete and innovation ability and financial standing and development potential and corporate credibility, five aspects to determine the evaluation index. Establish evaluation index system, the application of fuzzy comprehensive method to analyze the bid scheme offered by the tender.Results: According to the maximum subordinate principle, the evaluation value of the bidder is 0.28, the evaluation value of the B tender is 0.32, the value of the bid quotient is 0.23. Comparison of the comprehensive evaluation of the bid evaluation of the tender score of three, B the highest bid quotient, choose B tender bid.Conclusion:Facing different bidders, in the case of each of the advantages and making program quantification, conducting analysis of fuzzy synthetic method can realize the reasonable choice for medical equipment suppliers.

Study on purchase management of medical equipment based on ternary linear regression model / 中国医学装备

Objective:To pursue a scientific approach for medical equipment purchase, set up a standard purchase model, and try to transform the extensive and empirical way in purchase management into a scientific way.Methods: Analyze and test the data using linear regression method on yearly revenue, equipment value, yearly volume of work and yearly maintenance and repairs fee for 25 kinds of equipment in one hospital.Results: Assuming other parameters do not change, for each additional 10,000 yuan in equipment value, the revenue of the hospital increases by 14,858 yuan; for each additional 10,000 times in the volume of work, the revenue increases by 2,214,407 yuan; for each additional 10,000 yuan in maintenance, the revenue decreases by 132,683 yuan.Conclusion: Based on the scientific approach on equipment purchase management, we should improve the efficiency of medical equipment usage, scientifically mange the maintenance and repairs of equipment, in order to provide more accurate information and data for equipment purchase in hospital and make the purchase management more scientific, objective and rational.

Clinical analysis of primary hyperparathyroidism with kidney stones: 23 cases report / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the clinical characteristics of primary hyperparathyroidism (PHPT) with kidney stones.</p><p><b>METHODS</b>The clinical data of 23 cases undergoing diagnostic evaluation and surgery for PHPT combined with kidney stones between January 2004 and February 2012 was retrospectively analyzed. The 23 cases had undergone preoperative parathyroid neck color ultrasound, CT or (99)mTc-methoxy isobutyl isonitrile ((99)mTc-MIBI) diagnosis. The surgical treatment included parathyroid disease and kidney stones. The intravenous calcium, phosphorus and serum intact parathyroid hormone (iPTH) levels, 24 hours urinary calcium concentrations were measured 3 days before and 7 days after surgery.</p><p><b>RESULTS</b>There were 8 male and 15 female patients. The stone diameter were (3.2 ± 0.7) cm (range 2.1-4.0 cm). All patients did both parathyroid surgery and kidney surgery. The statistical discrepancy of serum calcium (there were (3.31 ± 0.39) mmol/L before surgery and (2.12 ± 0.18) mmol/L at 7 days after surgery, t = 11.26), serum phosphorus ((0.70 ± 0.09) and (1.21 ± 0.21) mmol/L in before and after surgery respectively, t = 10.53), iPTH (there were (28.8 ± 10.0) pmol/L before surgery and (3.6 ± 2.6) pmol/L after surgery, t = 12.83) and 24-hours urine calcium (there were (7.2 ± 3.1) mmol/d before surgery and (3.6 ± 2.5) mmol/d after surgery, t = 8.81) before and after the operation was significant (all P < 0.01). PTH concentration with serum calcium concentration correlation coefficient was r = 0.59 (P < 0.01). Eighteen patients (78.3%) had solitary parathyroid adenomas, two patients (8.7%) had multiple parathyroid adenomas, and three patients (13.0%) had multiglandular hyperplasia confirmed at surgery and histology. During follow-up, 8 patients had stone recurrence and 3 patients were did operation again to deal with renal stone within 2 years. Among them, 7 cases were normal, 1 case of parathyroid adenomas recurrence and reoperation.</p><p><b>CONCLUSIONS</b>The parathyroid operation may reduce the calculus recurrence remarkably. Early diagnosis and treatment of primary hyperparathyroidism is helpful to reduce the calculus recurrence and preserve the renal function.</p>

Effects of Surface Modification on Biocompatibility of Magnesium Alloy WE42 / 天津医药

Objective: To evaluate the effects of micro-arc oxidation (MAO) and poly-L-lactic acid (PLLA) surface-modification on the biocompatibility of magnesium alloy WE42. Methods: Micro-arc oxidation surface-modificated WE42 (MAO/WE42) materials and MAO+PLLA surface-modificated WE42(MAO+PLLA/WE42) materials were prepared. The surface topography of materials in the physiological environment was observed in vitro by scanning electron microscopy. The human umbilical vein endothelial cells(HUVECs) were treated by leaching liquor of materials. The relative growth rate(RGR) was assessed by MTT assay to evaluate the level of cytotoxicity. The coagulation time(PT, RT) and hemolytic ratio were determined to evaluate the blood compatibility of those materials. Results: The observation of scanning electron microscopy indicated that WE42 corroded seriously after immersion. There were no obvious corrosion holes on the surface of MAO/WE42 and MAO+PLLA/WE42 materials after immersion. It was found that there were good anticoagulant properties but no apparent cytotoxicity in MAO/WE42 and MAO+PLLA/WE42 materials. The results of hemolysis test showed that there were lower hemolysis rates in MAO and MAO+PLLA materials than that of WE42. The material of MAO+PLLA possessed the better anti-hemolytic properties than that of MAO(P < 0.01). Conclusion: Micro-arc oxidation surface modification improved the biocompatibility of WE42. PLLA sealing treatment improved the anti-hemolytic performance of WE42. MAO+PLLA provided a safe drug-loading surface for drug-eluting stents of magnesium alloy.