Association between the overall burden of comorbidity and Ct values among the older patients with Omicron infection: Mediated by inflammation.

Objectives: To investigate the associations between the overall burden of comorbidity, inflammatory indicators in plasma and Ct values among the elderly with COVID-19. Methods: We conducted a retrospective observational study. The results of each nucleic acid test of during hospitalization were obtained. Linear regression models assessed the associations between the overall burden of comorbidity, inflammatory indicators in plasma and Ct values among the elderly. A causal mediation analysis was performed to assess the mediation effects of inflammatory indicators on the association between the overall burden of comorbidity and Ct values. Results: A total of 767 COVID-19 patients aged ≥ 60 years were included between April 2022 and May 2022. Patients with a high burden of comorbidity had significantly lower Ct values of the ORF gene than subjects with a low burden of comorbidity (median, 24.81 VS 26.58, P < 0.05). Linear regression models showed that a high burden of comorbidity was significantly associated with higher inflammatory responses, including white blood cell count, neutrophil count and C-reactive protein. Also, white blood cell count, neutrophil count, C-reactive protein and the overall burden of comorbidity assessed by age-adjusted Charlson comorbidity index were independent risk factors for the Ct values. A mediation analysis detected the mediation effect of white blood cells on the association between the burden of comorbidity and Ct values, with the indirect effect estimates of 0.381 (95% CI: 0.166, 0.632, P < 0.001). Similarly, the indirect effect of C-reactive protein was -0.307 (95% CI: -0.645, -0.064, P = 0.034). White blood cells and C-reactive protein significantly mediated the relationship between the burden of comorbidity and Ct values by 29.56% and 18.13% of the total effect size, respectively. Conclusions: Inflammation mediated the association between the overall burden of comorbidity and Ct values among elderly with COVID-19, which suggests that combined immunomodulatory therapies could reduce the Ct values for such patients with a high burden of comorbidity.

Towards fast sensing along ultralong BOTDA: flatness enhancement by utilizing injection-locked dual-bandwidth probe wave.

Brillouin optical time-domain analysis (BOTDA) using distributed Brillouin amplification (DBA) only requires a milliwatt-level pump to achieve a sensing range beyond 100 km, which provides a powerful tool for temperature/strain sensing. However, similar to the majority of other long-range BOTDAs, the state-of-the-art reports require > 1000 times average, severely restricting the sensing speed. The blind area over tens of kilometers caused by the nonuniform Brillouin response and parasitic amplitude modulation (AM) are crucial factors affecting the signal-to-noise ratio (SNR). Here, a comprehensive performance optimization and substantial enhancement for BOTDA sensors was presented by the direct demodulation of an injection-locked dual-bandwidth probe wave. Injection locking (IL) can completely eliminate the impact of AM noise; dual-bandwidth probe enables self-adaptive pulse loss compensation, thereby intensifying the SNR flatness along the ultralong fiber, and direct probe demodulation can overcome nonlocal effects and allows ∼19.7 dB enhancement of probe input power. Therefore, using only 100 times average, ∼148.3 km sensing, and ∼5 m spatial resolution were achieved with < ∼0.8 MHz standard deviation of Brillouin frequency shift (BFS) over a broad range (∼131.7 km). The reduction in averages was more than 10 times that of the reported majority of long-range BOTDAs. Such performances were achieved without using time-consuming or post-processing techniques, such as optical pulse coding and image denoising. Because this approach is compatible with optical chirp chain technique without frequency sweeping, fast acquisition (0.3 s) was also realized, which has the potential for fast sensing at 3.3 Hz along a ∼150 km fiber.

Increased multidrug resistant isolates: new clinical burdens for 66 hospitals in Shanghai, 2015 to 2017.

BACKGROUND: To investigate the etiology of urinary tract and respiratory infections and the rate of drug resistant bacteria in Shanghai from 2015 to 2017, provide the support to the promotion of the correct clinical etiological specimens detection. METHODS: The retrospective questionnaire survey was conducted to obtain the antibiotic prescription rate, pathogen detection rate, and isolation rate of drug-resistant bacteria of the inpatients in 66 hospitals of Shanghai in 2015 and 2017. RESULTS: Although the detection rate of multidrug-resistant bacteria in sputum specimens has decreased, the clinical pathogen detection still relied mainly on sputum specimens in 2017. Among the sputum specis, the detection rates of extended-spectrum ß-lactamase-producing Escherichia (ESBL-ESC), extended-spectrum ß-lactamase Klebsiella pneumoniae (ESBL-KP), carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA) and methicillin-resistant Staphylococcus aureus (MRSA) in 2017 were 66.67%, 32.46%, 61.74%, 32.01% and 58.55% respectively. The detection rates of ESBL-ESC, ESBL-KP, CRAB, CRPA in 2017 were increased while the MRSA was decreased than 2015 (P<0.001). Among the blood samples, the detection rates of ESBL-ESC, ESBL-KP, CRAB, CRPA, MRSA and vancomycin-resistant Enterococcus sp (VRE) in 2017 were 53.71%, 31.43%, 50.80%, 19.43%, 43.87% and 0.55% respectively. The detection rates of ESBL-KP, CRAB, CRPA and MRSA increased while the rates of ESBL-ESC and VRE decreased compared with 2015 (P<0.005). The pathogens of multi-drug resistant bacteria were mainly detected from sputum specimens in 2017, which were all higher than detected from the blood specimens (P<0.001). CONCLUSIONS: Most of the multi-drug resistant bacteria in Shanghai, especially in Acinetobacter baumannii or Pseudomonas aeruginosa are mainly detected from sputum specimens, indicating that the actual drug resistance may be overestimated.

Colonization of Toxigenic Clostridium difficile Among Intensive Care Unit Patients: A Multi-Centre Cross-Sectional Study.

Background:Clostridium difficile (CD) is a major cause of healthcare-associated infections and antibiotic-associated diarrhea in hospitalized patients worldwide. Carriers of toxigenic CD (tCD) have a higher risk of developing CD infections and can transmit CD to the environment and susceptible patients. However, little is known regarding the carriers and transmission of tCD in China. Methods: A multi-center cross-sectional study of tCD colonization (tCDC) was conducted from October 24 to 31, 2014, at 33 hospitals in Shanghai, China. Rectal swabs or stool samples were collected and tested, and the clinical and demographic status, epidemiological data, and blood parameters of 531 participants were recorded. The status of tCDC was defined by a positive result on the nucleic acid amplification test for the tcdA (toxin A), tcdB (toxin B), and cdtAB (toxin CDT) genes after positive bacterial culture. Results: The overall prevalence of CD colonization (CDC) was 19.02%, tCDC accounted for 92.08%, and A+B+CDT- was the dominant genotype (87.13%). The CD infection (CDI) prevalence was 1.51%. Potential tCDC-associated factors were admission to secondary grade hospitals, a body mass index <18.5, hospitalization during the previous 30 days, underlying diseases (including hypertension, diabetes mellitus, coronary heart disease, and respiratory failure), diarrhea during the previous 7 days, and exposure to fluoroquinolones or lansoprazole. Conclusions: This study reveals the prevalence of CDC and tCDC in Shanghai, elucidates several associated factors, contributes to the awareness of the current epidemiology in parts of eastern China and provides new insights for further study and infection control practices.

[Interaction between long noncoding RNA and environmental factors on coronary heart disease].

OBJECTIVE: To investigate the role of leukocyte long noncoding RNA(lncRNA) and environmental factors on coronary heart disease(CHD). METHODS: A case-control study was conducted in a hospital in Fuzhou City by using stratified random sampling method during March 2015 and December 2017. The related surveys included questionnaire investigation, physical examination and laboratory detection. And real-time fluorescence quantitative PCR was used to detect the expression of lncRNA(NR_027032, NR_047116 and NR_104181) in case group and control group. Multivariate Logistic regression models and crossover analysis were used to analyze the interaction and association of environmental factors and lncRNA on CHD. RESULTS: Wilcoxon rank sum test indicated that: The expression levels of NR_027032, NR_047116 and NR_104181 in CHD were lower than those in control group, the difference was statistically significant(P<0.05). Multivariate Logistic regression analysis showed that the low expression of NR_027032, NR_047116 and NR_104181 may increase the risk of CHD. Crossover analysis showed that the risk of CHD was 19.053 times(95% CI 5.159-70.361) in the presence of overweight and low expression of NR_047116 than that in the normal condition. And the additive model between the two groups was statistically significant(U=1.999, P=0.046). The evaluation indexes were S=0.598, AP=10.070 and RERI=0.629. CONCLUSION: CHD is the result of environmental factors and genetic factors. The association and additive effect of NR_047116 low expression and overweight may increase the risk of CHD.

A survey of sharps injuries and occupational infections among healthcare workers in Shanghai.

BACKGROUND: Healthcare workers (HCWs) are at greater risk of occupational exposure to sharp injuries in their daily routine work, which is extremely worrying due to the potential risk of transmitting bloodborne pathogens. This study aims to assess what procedures and factors present the greatest risk of sharp injuries to HCWs in Shanghai and to provide an evidence base for improving measures to reduce sharps injuries. METHODS: A cross-sectional study was administered to all HCW who might be exposed to sharp instruments in 81 hospitals in Shanghai. According to the voluntary, investigate as many HCWs as possible and get feedbacks N=61,309. The survey addressed the sharp injury (SI) incidents, SIs of common instruments, SIs of common locations, SIs of operating procedures, SIs of common instruments and common sources of SI occurrences. Statistical analysis was performed using the SPSS program. RESULTS: A total of 61,309 HCWs were surveyed for this study, and 935 (1.53%) HCWs experienced the various types of sharp injuries in one month. Of the 1,140 sharp injuries, 292 (25.61%) sharp injuries were reported, and 815 (71.49%) sharp injuries were traced to their sources. Interns experienced the highest proportion of sharps injuries (4.12%). General wards were the most common location where sharp injuries occurred to HCWs (36.05%), while disposable syringes were the most common medical devices that caused sharp injuries (32.11%). Nurses, doctors and logistical workers who did not receive relevant training had a higher incidence of SI (4.40%, 4.95% and 4.03%, respectively) than those who received training (1.58%, 1.03% and 0.67%, respectively, P<0.001). HBV infection was the main source of exposure to sharp injuries, with scalpel cuts being the most common related occurrence. CONCLUSIONS: Sharp injuries occur among HCWs in Shanghai dented optimism. There are multiple high-risk factors for SI and exposure to blood-borne pathogens in their work such as interns, general wards, disposable syringes, and lack of relevant training. HBV infection was the main source of exposure to sharp injuries. As such, medical institutions shall pay closer attention to this topic.

Hypomethylation of the Angiotensin II Type I Receptor (AGTR1) Gene Along with Environmental Factors Increases the Risk for Essential Hypertension.

OBJECTIVES: The present study aimed to evaluate the hypertension status of community residents, analyze environmental and epigenetic factors, and propose prevention measures for hypertension. METHODS: In our study, different methylation levels were distinguished utilizing melting temperature (Tm) values in both the case and the control group. Multiple logistic regression analysis was used to estimate the risk of having essential hypertension (EH) between hypertensive and nonhypertensive participants. A receiver-operating characteristic curve was used to analyze Tm cutoff levels of methylation. RESULTS: The average DNA Tm was 71.784 with a standard deviation of 0.210. The Tm value of community residents (Fujian, China) was inversely correlated with systolic and diastolic blood pressure. Student t test analysis showed a clear separation in Tm expression levels between the hypertensive and the control group (p < 0.05). The Tm value was lower in the hypertension group than in the normotensive group. Multivariate regression analysis showed that high levels of DNA methylation were a protective factor in hypertension with adjustment of demographic and environmental factors, whereas when the Tm value increased by 0.1 units, the risk of hypertension was reduced by 0.652 times. Patients that smoked and consumed an irregular diet demonstrated a lower degree of methylation in the presence of hypertension. CONCLUSIONS: DNA methylation affects the risk for the development of hypertension; therefore, epigenetic markers could be used to measure hypertension levels to help elucidate the pathogenesis of EH.

[Relationships among long noncoding RNA, environmental factors and hypertension].

OBJECTIVE: To understand the main environmental factors of hypertension, and to explore the relationship between hypertension and leukocyte long noncoding RNA. METHODS: A case-control study was conducted in a hospital in Fuzhou City by using stratified random sampling method between Nov. 2014 and Jun. 2015 including 382 essential hypertension patients and 382 control subjects. The related surveys included questionnaire investigation, physical examination and laboratory detection. Real-time PCR method was used to compare the expression of long non-coding RNA( NR_104181 and NR_027032) in the case group with that of in the control group. Multiple factor Logistic regression was used to analyze the association of environmental factors, long noncoding RNA and the risk of hypertension. RESULTS: Multiple factor Logistic regression analysis revealed that the main risk factors of hypertension included: salty diet( OR = 1. 732, 95% CI 1. 204-2. 493), anxiety( OR = 1. 746, 95% CI 1. 326-2. 298), BMI ≥ 24( OR = 1. 475, 95% CI 1. 030-2. 111), abdominal obesity( OR = 1. 836, 95% CI 1. 229-2. 742), family history of hypertension( OR = 3. 004, 95% CI 2. 118-4. 261). The main protective factor of hypertension included: physical activity( OR = 0. 776, 95% CI0. 620-0. 972). Wilcoxon rank sum test indicated that: The expression level of NR_104181 in hypertension was higher than that in control group, the difference was statistically significant( P < 0. 05). The expression level of NR_027032 in hypertension was lower than that in control health group, the difference was statistically significant( P < 0. 05). Multiple factor Logistic regression analysis showed that controlling for salty diet, anxiety, abdominal obesity and physical activity, peripheral blood leukocytes NR_104181 high expression( OR = 2. 658, 95% CI 1. 109-6. 370), NR_ 027032 low expression( OR = 0. 179, 95% CI 0. 057-0. 560) were possibly related to the risk of hypertension. CONCLUSION: Hypertension is the result of environmental factors and genetic factors, and lncRNA may be associated with the risk of hypertension.

Independent and combined effects of environmental factors and miR-126, miR-143, and miR-145 on the risk of coronary heart disease.

OBJECTIVE: To evaluate the effects of environmental factors and microRNAs (miRNAs) (miR-126, miR-143, and miR-145) on the risk of coronary heart disease (CHD). METHODS: A frequency-matched case-control study (450 patients, 450 controls) was conducted from April 2014 to December 2016 in Fuzhou City, China. Environmental factors were investigated using a self-administered questionnaire, and the expression levels of miR-126, miR-143, and miR-145 were determined by quantitative real-time Polymerase Chain Reaction (PCR) in peripheral blood mononuclear cells. Unconditional logistic regression models were used for statistical evaluation. RESULTS: Alcohol consumption, high-salt diets, high-intensity work, and lack of physical activity were significantly associated with increased CHD risk, whereas light diet was significantly associated with decreased risk. MiR-126, miR-143, and miR-145 were highly expressed in the CHD group compared with the control group. After adjustment for other environmental factors, unconditional logistic regression results revealed that miR-126, miR-143, and depression were the independent risk factors of CHD, and light diet was the independent protective factor of CHD. CONCLUSIONS: Our data suggest that a family history of CHD, anxiety, and alcohol consumption was significantly associated with increased CHD risk, whereas light diet was significantly associated with decreased risk. Furthermore, miR-126 and miR-143 in combination with several risk factors, could play a joint role in the development of CHD. Therefore, it is necessary to manage patients with CHD in all directions and multiple level.