The impact of the COVID-19 pandemic on the trend of ventilator associated pneumonia incidence in a non-COVID-19 dedicated hospital.

INTRODUCTION: Ventilator associated pneumonia (VAP) is one of the most common hospital-acquired infections for intensive care units in China. Since the COVID-19 outbreak, "Lockdown Wuhan" and other infection control strategies had been implemented in China. The impact of the policies on VAP prevention was estimated in a non-COVID-19 dedicated hospital. METHODOLOGY: We analyzed the VAP trends of 6 intensive care units in a non-COVID-19 dedicated hospital from 2018 to 2020 by Joinpoint regression analysis. The information related to infected VAP patients, VAP surveillance were retrieved from an active surveillance system. RESULTS: There was an obvious decrease in the overall admissions and inpatients of ICUs since January 2020. The overall incidence of VAP was 6.1 episodes per 1000 IMV days. The 30-day case fatality was 16.8%. Generally, the utility rate of IMV ranged from 18.2% to 38.9% respectively, raising with the monthly percent change (MPC): 1.5% [95% confidence interval (CI): 0.8%, 2.2%] from January 2018 to February 2020 by Joinpoint regression analysis. A continuous decline with the MPC: -1.9% (95% CI: -3.2%, -0.5%) of VAP incidence was demonstrated. However, this trend varied among the different ICUs. We found no significant difference neither in 30-day case fatality nor pathogens of VAP patients. CONCLUSIONS: By Joinpoint regression analysis, we can see February 2020 was an important time point. The surveillance indicators were changed, which influenced the VAP incidence.

Prediction Model for Severe Mycoplasma pneumoniae Pneumonia in Pediatric Patients by Admission Laboratory Indicators.

OBJECTIVE: The purpose of this study was to develop a model for predicting severe Mycoplasma pneumoniae pneumonia (SMPP) in pediatric patients with Mycoplasma pneumoniae pneumonia (MPP) on admission by laboratory indicators. METHODS: Pediatric patients with MPP from January 2019 to December 2020 in our hospital were enrolled in this study. SMPP was diagnosed according to guideline for diagnosis and treatment of community-acquired pneumonia in children (2019 version). Prediction model was developed according to the admission laboratory indicators. Receiver operating characteristic curve and Goodness-of-fit test were analyzed for the predictive value. RESULTS: A total of 233 MPP patients were included in the study, with 121 males and 112 females, aged 4.541 (1-14) years. Among them, 84 (36.1%, 95% CI 29.9-42.6%) pediatric patients were diagnosed as SMPP. Some admission laboratory indicators (immunoglobulins M (IgM), eosinophil proportion, eosinophil count, hemoglobin, erythrocyte sedimentation rate (ESR), total protein, albumin and prealbumin) were found statistically different (p < 0.05) between non-SMPP group and SMPP group. Logistic regress analysis showed IgM, eosinophil proportion, eosinophil count, ESR and prealbumin were independent risk factors for SMPP. According to these five admission laboratory indicators, the prediction model for SMPP in pediatric patients was developed. The area under curve of the prediction model was 0.777, and the goodness-of-fit test showed that the predicted SMPP incidence by the model was consistent with the actual incidence (χ2 = 244.51, p = 0.203). CONCLUSION: We developed a model for predicting SMPP in pediatric patients by admission laboratory indicators. This model has good discrimination and calibration, which provides a basis for the early identification SMPP on admission. However, this model should be validated by multicenter studies with large sample.

Comparative transcriptomic analysis reveals that TPX2 and AURXA are involved in porcine PCV2 infection.

Porcine circovirus type 2 (PCV2) has been a notorious killer for the pig industry, causing substantial economic losses worldwide. However, its pathogenesis is still poorly understood. Comparative transcriptomic analysis and weighted gene co-expression network analysis (WGCNA) were performed in different porcine tissues after PCV2 infection. Our comparative transcriptomic analysis obtained 40 key differentially expressed genes (DEGs), and our WGCNA identified 458 hub genes. Significantly, both TPX2 microtubule nucleation factor (TPX2) and Aurora kinase A (AURKA) are included in these key DEGs and hubs genes. Our gene ontology (GO) analysis indicated that the key DEGs and hub genes participated in cell cycle regulation and immune response. The expressive levels of TPX2 and AURKA went down in the spleen but up in the kidneys after infection with PCV2. We conclude that TPX2 and AURKA played an essential role in PCV2 infection.

[Clinical outcomes of hip arthroscopic treatment for femoroacetabular impingement:a comparative study between Inside-out and Outside-in approach].

OBJECTIVE: To compare the clinical outcomes and complications of hip arthroscopic treatment for femoroacetabular impingement (FAI) performed with either Inside-out or Outside-in approach. METHODS: The clinical date of 48 patients with FAI treated by hip arthroscopy surgery and follow-up from June 2016 to June 2019 were retrospectively analyzed. According to the different operative methods, the patients were divided into two groups. Inside-out group, from central compartment to peripheral compartment;Outside-in group, from peripheral compartment to central compartment. There were 14 males and 10 females in Inside-out group with an averageage of (39.8±7.6)years old, 13 males and 11 females in Inside-out group with an average age of (39.5±9.1)years old in Outside-in group. There was no significant difference in age, gender, body mass index, side, impingement type, medical history and follow-up time between the two groups. The complication occurrence rate, modified Harris hip score (mHHS)and nonarthritic hip score (NAHS) were compared between these two groups. RESULTS: The mHHs and NAHS scores of the two groups were significantly higher than those before operation, but there was no significant difference between the two groups (P>0.05). In the Inside-out group, there were 4 cases of nerve traction injury and 3 cases of iatrogenic injury, while only 1 case of nerve traction injury occurred in the Outside-in group. The incidence of complications in the inside out group was higher than that in the outside in group (16.7% vs 4.2%, χ2=5.400, P=0.020). CONCLUSION: Both hip arthroscopic surgery methods can obtain satisfactory clinical efficacy in the treatment of FAI, but the incidence of postoperative complications of Outside-in surgical method is lower. The out-side in method can be preferentially selected for the patients with the indications of operation.

Risk factors for carbapenem-resistant Klebsiella pneumoniae infection relative to two types of control patients: a systematic review and meta-analysis.

BACKGROUND: Studies on risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) infection have provided inconsistent results, partly due to the choice of the control group. We conducted a systematic review and meta-analysis to assess the risk factors for CRKP infection by comparing CRKP-infected patients with two types of controls: patients infected with carbapenem-susceptible Klebsiella pneumoniae (comparison 1) or patients not infected with CRKP (comparison 2). METHODS: Data on potentially relevant risk factors for CRKP infection were extracted from studies indexed in PubMed, EMBASE, Web of Science or EBSCO databases from January 1996 to April 2019, and meta-analyzed based on the outcomes for each type of comparison. RESULTS: The meta-analysis included 18 studies for comparison 1 and 14 studies for comparison 2. The following eight risk factors were common to both comparisons: admission to intensive care unit (ICU; odds ratio, ORcomparison 1 = 3.20, ORcomparison 2 = 4.44), central venous catheter use (2.62, 3.85), mechanical ventilation (2.70, 4.78), tracheostomy (2.11, 8.48), urinary catheter use (1.99, 0.27), prior use of antibiotic (6.07, 1.61), exposure to carbapenems (4.16, 3.84) and exposure to aminoglycosides (1.85, 1.80). Another 10 risk factors were unique to comparison 1: longer length of hospital stay (OR = 15.28); prior hospitalization (within the previous 6 months) (OR = 1.91); renal dysfunction (OR = 2.17); neurological disorders (OR = 1.52); nasogastric tube use (OR = 2.62); dialysis (OR = 3.56); and exposure to quinolones (OR = 2.11), fluoroquinolones (OR = 2.03), glycopeptides (OR = 3.70) and vancomycin (OR = 2.82). CONCLUSIONS: Eighteen factors may increase the risk of carbapenem resistance in K. pneumoniae infection; eight factors may be associated with both K. pneumoniae infections in general and CRKP in particular. The eight shared factors are likely to be 'true' risk factors for CRKP infection. Evaluation of risk factors in different situations may be helpful for empirical treatment and prevention of CRKP infections.

SpinachDB: A Well-Characterized Genomic Database for Gene Family Classification and SNP Information of Spinach.

Spinach (Spinacia oleracea L.), which originated in central and western Asia, belongs to the family Amaranthaceae. Spinach is one of most important leafy vegetables with a high nutritional value as well as being a perfect research material for plant sex chromosome models. As the completion of genome assembly and gene prediction of spinach, we developed SpinachDB (http://222.73.98.124/spinachdb) to store, annotate, mine and analyze genomics and genetics datasets efficiently. In this study, all of 21702 spinach genes were annotated. A total of 15741 spinach genes were catalogued into 4351 families, including identification of a substantial number of transcription factors. To construct a high-density genetic map, a total of 131592 SSRs and 1125743 potential SNPs located in 548801 loci of spinach genome were identified in 11 cultivated and wild spinach cultivars. The expression profiles were also performed with RNA-seq data using the FPKM method, which could be used to compare the genes. Paralogs in spinach and the orthologous genes in Arabidopsis, grape, sugar beet and rice were identified for comparative genome analysis. Finally, the SpinachDB website contains seven main sections, including the homepage; the GBrowse map that integrates genome, genes, SSR and SNP marker information; the Blast alignment service; the gene family classification search tool; the orthologous and paralogous gene pairs search tool; and the download and useful contact information. SpinachDB will be continually expanded to include newly generated robust genomics and genetics data sets along with the associated data mining and analysis tools.

Metal-promoted intermolecular electron transfer in tetrathiafulvalene-thiacalix[4]arene conjugates and tetrachlorobenzoquinone.

In this work, two series of tetrathiafulvalene (TTF) and thiacalix[4]arene (TCA) conjugates (TTF-TCA) were designed by CuAAC click reactions. The results obtained from NMR and (1)H NMR NOE indicated that their conformations of thiacalix[4]arene framework may prefer to 1,3-alternate. The cyclic voltammograms of four TTF-TCA compounds containing electroactive TTF units were provided. Meanwhile, their intermolecular electron-transfer (ET) behaviors with tetrachlorobenzoquinone (Q) mediated by different metal ions, Sc(3+), Pb(2+), Ag(+), Cd(2+), and Zn(2+), in CH3CN-CH2Cl2 (V/V = 1:1) solution were studied and analyzed via UV-vis spectroscopy. It was determined that intermolecular ET between each TTF-TCA and Q ensemble was not observed without introduction of the metal ions mentioned above. The added specified metal ions most likely induced the intermolecular ET between TTF-TCA and Q ensemble, and the effects of Sc(3+) functions were the most imperative. The intermolecular ET also proved to be reliant on the structure of TTF-TCA, where TTF-TCA 7a and 7b were more effective than TTF-TCA 6a and 6b. The difference may be credited to TTF-TCA 7a or 7b possessing two independent TTF pendants and providing a more synergic coordination among the TTF radical cation and Q radical anion with a metal ion.

[Case-control study on needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding for the treatment of low back pain caused by lumbar facet osteoarthritis].

OBJECTIVE: To study the clinical efficacy of needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding to treat low back pain caused by lumbar facet osteoarthritis. METHODS: From July 2009 to June 2011, 60 patients with low back pain caused by lumbar facet osteoarthritis were reviewed,including 34 males and 26 females, ranging in age from 39 to 73 years old,averaged 61.9 years old; the duration of the disease ranged from 6 to 120 months, with a mean of 18.9 months. All the patients were divided into two groups, 30 patients (18 males and 12 females, ranging in age from 39 to 71 years old, needle-knife group) were treated with needle-knife to cut off medial branch of the lumbar posterior ramus under C -arm guiding and the other 30 patients(16 males and 14 females, ranging in age from 41 to 73 years old, hormone injection group) were treated with hormone injection in lumbar facet joint under C-arm guiding. The preoperative JOA scores and the scores at the 1st, 12th and 26th weeks after treatment were analyzed. RESULTS: Before treatment,the JOA scores between the two groups had no significant difference (P= 0.479); after 1 week of treatment, the JOA scores between the two groups had significant difference (P= 0.040), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (58.73+/-18.20)% in needle-knife group and (71.10+/-22.19)% in hormone injection group; after 12 weeks of treatment, the JOA scores between the two groups had no significant difference(P=0.569), and the improvement rate between the two groups had no significant difference,which were (50.09+/-19.33)% in the needle-knife group and (48.70+/-18.36)%) in the hormone injection group; after 26 weeks of treatment,the JOA scores between the two groups had significant difference (P=0.000), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (48.56+/-28.24)% in needle-knife group and (15.62+/-11.23 )% in hormone injection group. CONCLUSION: Using needle-knife to cut off the medial branch of the lumbar posterior ramus could get longer efficacy than hormone injection in the treatment of lumbar facet osteoarthritis.

The study on biocompatibility of porous nHA/PLGA composite scaffolds for tissue engineering with rabbit chondrocytes in vitro.

OBJECTIVE: To examine the biocompatibility of a novel nanohydroxyapatite/poly[lactic-co-glycolic acid] (nHA/PLGA) composite and evaluate its feasibility as a scaffold for cartilage tissue engineering. METHODS: Chondrocytes of fetal rabbit were cultured with nHA/PLGA scaffold in vitro and the cell viability was assessed by MTT assay first. Cells adhering to nHA/PLGA scaffold were then observed by inverted microscope and scanning electron microscope (SEM). The cell cycle profile was analyzed by flow cytometry. RESULTS: The viability of the chondrocytes on the scaffold was not affected by nHA/PLGA comparing with the control group as it was shown by MTT assay. Cells on the surface and in the pores of the scaffold increased in a time-dependent manner. Results obtained from flow cytometry showed that there was no significant difference in cell cycle profiles between the coculture group and control (P > 0.05). CONCLUSION: The porous nHA/PLGA composite scaffold is a biocompatible and good kind of scaffold for cartilage tissue engineering.

Poly[[{µ(4)-2,2'-[butane-1,4-diylbis(sulfanedi-yl)]bis-(1,3,4-thia-diazole)}silver(I)] perchlorate sesquihydrate].

In the polymeric title compound, {[Ag(C(8)H(10)N(4)S(4))]ClO(4)·1.5H(2)O}(n), the Ag(I) atom has a slightly distorted trigonal-planar coordination geometry provided by three N-atom donors from the thia-diazole rings of three symmetry-related 2,2'-[butane-1,4-diylbis(sulfanedi-yl)]bis-(1,3,4-thia-diazole) ligands. Centrosymmetrically related Ag(I) atoms are bridged by the N-N fragments of rings, forming six-membered dinuclear metallacycles, which are further linked by the alkyl spacers of the thia-diazole ligands into a layer network extending parallel to (0-21). The crystal structure is stabilized by inter-molecular O-H⋯O hydrogen bonds. The O atoms of the perchlorate anion and one water mol-ecule are disordered over two sets of sites with refined occupancy ratios of 0.640 (6):0.360 (6) and 0.663 (11):0.337 (11), respectively. The second water molecule shows half-occupancy.

[Efficacy and safety of using denervation to treat the low back pain due to lumbar joint origin].

OBJECTIVE: To explore efficacy and safety of using denervation of dorsal medial branch to treat the low back pain due to lumbar joint origin. METHODS: From March 2009 to October 2010,10 patients with the low back pain due to lumbar joint origin were enrolled in this study including 6 males and 4 females with an average age of 56.4 years old (41 to 68). The average disease duration was 1.2 years (0.5 to 3). All patients were operated by blocking the dorsal medial branch. Single branch (dorsal medial branch of the involved level), dual branches (dorsal medial branches of the involved and the upper or lower level, 5 with the upper level, 5 with the lower level), three branches (dorsal medial branches of the involved and the upper and lower levels), four branches (dorsal medial branches of the involved and the upper two and lower levels) were blocked by 0.5% lidocaine 15 ml compounded with betamethasone injection 1 ml (10 mg/ml) and a cobalt ammonium injection 500 microg at the junction of the superior articular process and the transverse process. Low back pain VAS, average EMG of multifidus of the involved level and low back muscle strength were assessed and statistically compared. Low back muscle strength was measured by the back power meter. RESULTS: The mean low back pain VAS of the 10 patients in the preoperation was 6.85 +/- 1.55, in single branch blocked group was 5.80 +/- 1.05, in dual branches blocked group was 3.65 +/- 1.20, in three branches blocked group was 2.80 +/- 1.10 and in four branches blocked group was 2.75 +/- 1.15. Average EMG of multifidus was 69.25 +/- 2.13 in the preoperation,in single branch blocked group was 62.15 +/- 1.85, in dual branches blocked group was 51.25 +/- 1.28, in three branches blocked group was 47.30 +/- 1.85 and in four branches blocked group was 45.96 +/- 1.98. The mean low back muscle strength was 60 kg in the preoperation, in single branch blocked group was 55 kg,in dual branches blocked group was 48 kg, in three branches blocked group was 44 kg and in four branches blocked group was 43 kg. Among the dual branches blocked group,low back pain VAS and low back muscle strength in the dorsal medial branches of the involved and the upper level blocked showed great decline compared with those in the dorsal medial branches of the involved and the lower level blocked. CONCLUSION: It is effective by denervation of dorsal medial branch to treat the low back pain due to lumbar joint origin. There are significant difference in low back pain VAS between every two among the preoperation,single branch blocked group,dual branches blocked group and three branches blocked group. There is no significant difference between four branches blocked group and three branches blocked group. In low back muscle strength and average EMG of multifidus, compared with the preoperation group,there is no significant decline in single branch blocked and dual branches blocked group,and there is significant decline in three branches blocked and four branches blocked group. Therefore, single or dual dorsal medial branch blocked is safety. Among the dual branches blocked group, dorsal medial branches of the involved and the upper level blocked should be given priority to. There is a certain risk in three or four dorsal medial branches blocked which should be used with caution.

[Clinical study on surgical treatment for thoracolumbar burst fractures].

OBJECTIVE: To explore the choice of operative approach for thoracolumbar burst fractures and evaluate its clinical effects. METHODS: From September 2005 to March 2009, the clinical data of 94 patients with thoracolumbar burst fractures were analyzed retrospectively. Including 59 males and 35 femals with an average age of 36.8 years (ranged from 20 to 63). The fractures were classified according to Denis classification: 17 cases of type A, 32 cases of type B, 6 cases of type C, 24 cases of type D, 15 cases of type E. Neurological injuries were classified according to ASIA classification: 3 cases of grade A, 4 cases of type B, 23 cases of grade C, 38 cases of grade D, 26 cases of grade E. Among the patients, 42 cases were treated with reduction, decompression, internal fixation with pedicle-screw through posterior approach, meanwhile, of them, 18 cases with posterior-lateral bone graft fusion; 36 cases were treated with decompression, bone graft, through anterior approach, of them, 16 cases with TSRH system fixation and 20 cases with Zeplate system fixation; 16 cases (because of bone block intruded into vertebral canal leading to spinal cord compression ) were treated with anterior and posterior approach, internal fixation with pedicle-screw through posterior approach and subtotal vertebrectomy, decompression, titanium mesh cages bone graft fusion through anterior approach, meanwhile, of them, 8 cases with screw-rod and titanium steel plate system fixation. RESULTS: All patients obtained good results and were followed up from 9 to 52 months with an average of 22.8 months. Cobb angle were corrected from preoperatively (25.00 +/- 5.50) degrees to postoperatively (4.20 +/- 1.80) degrees. Height of anterior and posterior border of vertebral body improved from preoperatively (50.80 +/- 2.82)%, (79.30 +/- 3.08)% to postoperatively (94.85 +/- 1.80)%, (98.20 +/- 1.40)%, respectively. The ratio of protruded bones to the spinal canal anteroposterior diameter decreased from preoperatively (33.10 +/- 1.40)% to postoperatively (6.70 +/- 1.50)%. Sagittal abnormity were corrected; posterior convex angle and height were no markedly lost during follow-up; no internal fixation loosening and titanium mesh displacement were found. In the aspect of never function, except for 1 case of grade A there is no recovered others obtained different improvement, among them, from grade A to B was in 2 cases; B to C, D was in 2,2, respectively; C to D, E was 16,7, respectively; D to E was in 38 cases. CONCLUSION: The two factors decide surgical methods:the integrity of posterior ligamentous complex and nervous system function. Anterior approach refers to patients with incomplete spinal cord injury and anterior vertebral canal compression; posterior approach refers to patients with injury of posterior ligamentous complex; combination with anterior and posterior approach refers to patients with two injury factors.

[Surgical treatment of the old with degenerative lumbar spinal stenosis].

OBJECTIVE: To investigate the perioperative characteristics and surgical methods in treating the old with degenerative lumbar spinal stenosis. METHODS: From January 2000 to October 2007, 36 patients with degenerative lumbar spinal stenosis with the age more than 60 years,including 16 males and 20 females, the age from 60 to 81 years with an average of 67.5 years. Of all patients, 6 cases were treated by simple surgical decompression, 16 cases by decompressive laminectomy, 20 cases by decompressive laminectomy combined with internal fixation and fusion. RESULTS: No death cases occurred during perioperation and complication occurred in 14 cases, including cerebrospinal fluid leakage in 3 cases, incision late healed in 1 case, heart abnormal symptom in 1 case, respiratory infection in 1 case, gastrointestinal symptom in 4 cases, urinary system infection in 1 case, spirital symptom in 1 case. After symptomatic treatment, all complications improved. All the cases were followed up from 6 months to 5 years with an average of 2.5 years. Oswestry scoring improved from preoperative 45.66 +/- 7.12 to postoperative 16.80 +/- 5.75, there was significant difference between before and after operation (P < 0.05). CONCLUSION: The age and heath condition are not operative absolute contraindication in treating old with degenerative lumbar spinal stenosis,with the proper operation modus after controlling concomitant diseases, the surgical treatment could guarantee the satisfactory therapeutic effect.

[Surgical treatment for lumbar spinal stenosis by different methods].

OBJECTIVE: To discuss the relationship between decompression methods of lumbar spinal stenosis and outcomes. METHODS: From September 1996 to March 2007, 68 patients with degenerative lumbar spinal stenosis were investigated retrospectively. There were 40 males and 28 females with the mean age of 52.8 years (ranging from 32 to 78 years old). And the average history was 51 months. According to Hansraj classification of lumbar spinal stenosis and levels response to symptom,the classic lumbar spinal stenosis were treated with complete laminectomy and foramintomy (18 cases in group A), hemilaminectomy and foreminotomy (11 cases in group B), complete fenestration and foraminotomy (17 cases in group C); and other patients with complicated lumbar spinal stenosis (22 cases in group D) were treated with decompression and intervertebral fusion and internal fixation. The clinical results of all patients were analyzed according to JOA score (15 scoring method). RESULTS: All patients were followed up with an average of 64 months (ranging from 8 months to 11 years). At final follow-up,the improvement rate of JOA score in the group A,B,C,D was respectively (51.2 +/- 26.6)%, (60.7 +/- 21.1)%, (59.3 +/- 23.1)% and (59.1 +/- 22.7)%. These data were significantly difference than that of preoperative (P < 0.001). CONCLUSION: CT and MRI results combining with clinical symptom and sign is the key to determine decompressive extent; lumbar stability is the key to determine fixation and intervertebral fusion in treating lumbar spinal stenosis.

Domain structure and phase symmetry of multiferroic BiFeO3-PbTiO3 single crystals studied by piezoresponse force microscopy.

Piezoresponse force microscopy (PFM) was used to investigate the domain structure of multiferroic BiFeO3-PbTiO3 single crystals with morphotropic phase boundary (MPB) compositions. The PFM data demonstrate the piezoelectricity and the PFM domain responses under the designed experimental setup reveal the coexistence of a rhombohedral, a tetragonal, and an orthorhombic phases in the MPB crystals, which is consistent with the results of structural refinements based on X-ray diffraction data.