Efficacy of short- versus prolonged-courses of antimicrobial therapy for carbapenem-resistant Klebsiella pneumoniae bloodstream infections: A propensity score-matched cohort study.

BACKGROUND: As limited antibiotic options are available for the treatment of carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections (BSIs), the optimal treatment duration for CRKP BSIs is unclear. Our objective was to investigate whether short courses (6-10 days) are as effective as prolonged courses (≥11 days) of active antibiotic therapy for CRKP BSIs. METHODS: A retrospective cohort study comprising adults with monomicrobial CRKP BSI receiving a short or prolonged course of in vitro active therapy at a medical center was conducted between 2010 and 2021. Comparisons of two therapeutic strategies were assessed by the logistic regression model and propensity score analysis. The primary endpoint was 30-day crude mortality. Secondary outcomes included recurrent BSIs, the emergence of multidrug-resistant organisms and candidemia during hospitalization after completing antibiotic therapy for CRKP BSIs. RESULTS: Of 263 eligible adults, 160 (60.8%) were male, and the median (interquartile range) age was 69.0 (53.0-76.0) years. Common comorbidities included diabetes (143 patients, 54.4%), malignancy (75, 28.5%), cerebrovascular accident (58, 22.1%), and hemodialysis (49, 18.6%). The 30-day mortality rate was 8.4% (22 patients). Of 84 propensity score well-balanced matched pairs, the 30-day mortality was similar in the short-course and prolonged-course group (6.0% and 7.1%, respectively; P = 1.00). However, there were less episodes candidemia in the short-course group (1.2% versus 13.1%; odds ratio, 0.08; 95% confidence interval, 0.01-0.63; P = 0.005). CONCLUSION: Short courses of active therapy for CRKP BSIs demonstrate comparable clinical outcomes to prolonged courses and are associated with a lower risk of subsequent candidemia.

Koch Hierarchical Honeycomb: A Fractal-Based Design for Enhanced Mechanical Performance and Energy Absorption.

A novel energy-absorbing structure, the Koch hierarchical honeycomb, which combines the Koch geometry with a conventional honeycomb structure, is proposed in this work. Adopting a hierarchical design concept using Koch has improved the novel structure more than the honeycomb. The mechanical properties of this novel structure under impact loading are studied by finite element simulation and compared with the conventional honeycomb structure. To effectively verify the reliability of the simulation analysis, quasi-static compression experiments were conducted on 3D-printed specimens. The results of the study showed that the first-order Koch hierarchical honeycomb structure increased the specific energy absorption by 27.52% compared to the conventional honeycomb structure. Furthermore, the highest specific energy absorption can be obtained by increasing the hierarchical order to 2. Moreover, the energy absorption of triangular and square hierarchies can be significantly increased. All achievements in this study provide significant guidelines in the reinforcement design of lightweight structures.

Analysis of gene expression by ESTs from suppression subtractive hybridization library in Chenopodium album L. under salt stress.

To identify genes expression in Chenopodium album exposed to NaCl stress and screen ESTs related to salt stress, a subtractive suppression hybridization (SSH) library of C. album under salt stress was constructed in the present study. Random EST sequencing produced 825 high-quality ESTs with GenBank ID GE746311-GE747007, which had 301 bp of average size and were clustered into 88 contigs and 550 singletons. They were classified into 12 categories according to their function annotations. 635 ESTs (76.97%) showed similarities to gene sequences in the non-redundancy database, while 190 ESTs (23.03%) showed low or no similarities. The transcriptional profiles of 56 ESTs randomly selected from 347 unknown or novel ESTs of SSH library under varying NaCl concentration and at different time points were analyzed. The results indicated that a high proportion of tested ESTs were activated by salt stress. Four in 56 ESTs responded to NaCl were also enhanced in expression level when exposed to ABA and PEG stresses. The above four ESTs were validated by northern blotting which was consistent with the results of RT-PCR. The results suggested that genes corresponded to these ESTs might be involved in stress response or regulation. The complete sequences and detailed function of these ESTs need to be further studied.

[Characterization of root nodule and rhizobium of a Leguminosae ephemeral plant--Trigonella arcuata C. A. Mey in Xinjiang].

OBJECTIVE: We studied root nodule proliferation, nodule microstructure, genetic cluster and stress resistance of the rhizobium of Trigonella arcuata. METHODS: We characterized root nodule and rhizobium with various soil matrixes cultivation, paraffin section, resin semi-ultrathin section techniques, and 16S rRNA gene cluster analysis. RESULTS: (1) Plants grew in mixed soil (nutritious garden soil: poplar zone soil: desert sands = l:1:1), had the most nodule proliferation and bore the most pods. The shapes of nodule were palm- or ginger-like; (2) Microstructure of the nodule revealed five different parts differentiated within the nodule: epidermis (E), cortex (C), vascular bundle (VB), infected cells (IC) and uninfected cells (UIC); (3) Genetic cluster analysis of the full length 16S rRNA gene sequence (1377 bp) indicated that the rhizobium isolated shared the highest identities with Sinorhizobium meliloti; (4) The rhizobium could grow between 4 and 60 degrees C (20 min), pH 6.0-12.0 and 0-2% NaCl. For the antibiotic sensitivity, the rhizobium could not grow normally in medium with 25 microg/mL Kanamycin, Streptomycin or Cephalothin, except for 100 microg/mL Ampicillin. CONCLUSION: Good conditions of soil matrixes were important for nodulation of T. arcuata; A large quantity of cells in fascicular nodules were infected by rhizobia; 16S rRNA gene sequence of T. arcuata shared the highest identities with that of Sinorhizobium meliloti, and this strain was able to tolerate relatively higher temperature and alkalin.