Detection and population genetic analysis of Aedes albopictus (Diptera: Culicidae) based on knockdown resistance (kdr) mutations in the Yangtze River basin of China.

BACKGROUND: Aedes albopictus is an important vector of chikungunya, dengue, yellow fever and Zika viruses. Insecticides are often the most effective tools for rapidly decreasing the density of vector populations, especially during arbovirus disease outbreaks. However, the intense use of insecticides, particularly pyrethroids, has led to the selection of resistant mosquito populations worldwide. Mutations in the voltage-gated sodium channel (VGSC) gene are one of the main drivers of insecticide resistance in Ae. albopictus and are also known as "knockdown resistance" (kdr) mutations. Knowledge about genetic mutations associated with insecticide resistance is a prerequisite for developing techniques for rapid resistance diagnosis. Here, we report studies on the origin and dispersion of kdr haplotypes in samples of Ae. albopictus from the Yangtze River Basin, China; METHODS: Here, we report the results of PCR genotyping of kdr mutations in 541 Ae. albopictus specimens from 22 sampling sites in 7 provinces and municipalities in the Yangtze River Basin. Partial DNA sequences of domain II and domain III of the VGSC gene were amplified. These DNA fragments were subsequently sequenced to discover the possible genetic mutations mediating knockdown resistance (kdr) to pyrethroids. The frequency and distribution of kdr mutations were assessed in 22 Ae. albopictus populations. Phylogenetic relationships among the haplotypes were used to infer whether the kdr mutations had a single or multiple origins; RESULTS: The kdr mutation at the 1016 locus had 2 alleles with 3 genotypes: V/V (73.38%), V/G (26.43%) and G/G (0.18%). The 1016G homozygous mutation was found in only one case in the CQSL strain in Chongqing, and no 1016G mutations were detected in the SHJD (Shanghai), NJDX (Jiangsu) or HBQN (Hubei) strains. A total of 1532 locus had two alleles and three genotypes, I/I (88.35%), I/T (8.50%) and T/T (3.14%). A total of 1534 locus had four alleles and six genotypes: F/F (49.35%), F/S (19.96%), F/C (1.48%) and F/L (0.18%); S/S (23.66%); and C/C (5.36%). Haplotypes with the F1534C mutation were found only in Ae. albopictus populations in Chongqing and Hubei, and C1534C was found only in three geographic strains in Chongqing. Haplotypes with the 1534S mutation were found only in Ae. albopictus populations in Sichuan and Shanghai. F1534L was found only in HBYC. The Ae. albopictus populations in Shanghai were more genetically differentiated from those in the other regions (except Sichuan), and the genetic differentiation between the populations in Chongqing and those in the middle-lower reaches of the Yangtze River (Huber, Jiangsu, Jiangxi, and Anhui) was lower. Shanghai and Sichuan displayed low haplotype diversity and low nucleotide diversity. Phylogenetic analysis and sequence comparison revealed that the 1016 locus was divided into three branches, with the Clade A and Clade B branches bearing the 1016 mutation occurring mostly in Jiangsu and the Clade C branch bearing the 1016 mutation occurring mostly in Chongqing, suggesting at least two origins for 1016G. IIIS6 phylogenetic analysis and sequence comparison revealed that F1534S, F1534C and I1532T can be divided into two branches, indicating that IIIS6 has two origins; CONCLUSIONS: Combined with the distribution of kdr mutations and the analysis of population genetics, we infer that besides the local selection of pyrethroid resistance mutations, dispersal and colonization of Ae. albopictus from other regions may explain why kdr mutations are present in some Ae. albopictus populations in the Yangtze River Basin.

The effect of artificial light at night (ALAN) on the characteristics of diapause of Aedes albopictus.

BACKGROUND: Recently, the effect of artificial light at night (ALAN) on the physiology and behavior of insects has gradually attracted the attention of researchers and has become a new research topic. Aedes albopictus is an important vector that poses a great public health risk. Further studies on the diapause of Ae. albopictus can provide a basis for new vector control, and it is also worth exploring whether the effect of ALAN on the diapause of Ae. albopictus will provide a reference for the prevention and control of infectious diseases mediated by Ae. albopictus. METHODS: In this study, we experimentally studied the diapause characteristics of different geographical strains of Ae. albopictus under the interference of ALAN, explored the effect of ALAN on the diapause of Ae. albopictus and explored the molecular mechanism of ALAN on the diapause process through RNA-seq. RESULTS: As seen from the diapause incidence, Ae. albopictus of the same geographic strain showed a lower diapause incidence when exposed to ALAN. The differentially expressed genes (DEGs) were mainly enriched in signaling and metabolism-related pathways in the parental females and diapause eggs of the ALAN group. CONCLUSIONS: ALAN inhibits Ae. albopictus diapause. In the short photoperiod induced diapause of Ae. albopictus in temperate strain Beijing and subtropical strain Guangzhou, the disturbance of ALAN reduced the egg diapause rate and increased the egg hatching rate of Ae. albopictus, and the disturbance of ALAN also shortened the life cycle of Ae. albopictus eggs after hatching.

Possible potential spread of Anopheles stephensi, the Asian malaria vector.

BACKGROUND: Anopheles stephensi is native to Southeast Asia and the Arabian Peninsula and has emerged as an effective and invasive malaria vector. Since invasion was reported in Djibouti in 2012, the global invasion range of An. stephensi has been expanding, and its high adaptability to the environment and the ongoing development of drug resistance have created new challenges for malaria control. Climate change is an important factor affecting the distribution and transfer of species, and understanding the distribution of An. stephensi is an important part of malaria control measures, including vector control. METHODS: In this study, we collected existing distribution data for An. stephensi, and based on the SSP1-2.6 future climate data, we used the Biomod2 package in R Studio through the use of multiple different model methods such as maximum entropy models (MAXENT) and random forest (RF) in this study to map the predicted global An. stephensi climatically suitable areas. RESULTS: According to the predictions of this study, some areas where there are no current records of An. stephensi, showed significant areas of climatically suitable for An. stephensi. In addition, the global climatically suitability areas for An. stephensi are expanding with global climate change, with some areas changing from unsuitable to suitable, suggesting a greater risk of invasion of An. stephensi in these areas, with the attendant possibility of a resurgence of malaria, as has been the case in Djibouti. CONCLUSIONS: This study provides evidence for the possible invasion and expansion of An. stephensi and serves as a reference for the optimization of targeted monitoring and control strategies for this malaria vector in potential invasion risk areas.

Potential Global Distribution of the Invasive Mosquito Aedes koreicus under a Changing Climate.

Invasive alien species are a growing threat to natural systems, the economy, and human health. Active surveillance and responses that readily suppress newly established colonies are effective actions to mitigate the noxious consequences of biological invasions. Aedes (Hulecoeteomyia) koreicus (Edwards), a mosquito species native to East Asia, has spread to parts of Europe and Central Asia since 2008. In the last decade, Ae. koreicus has been shown to be a competent vector for chikungunya virus and Dirofilaria immitis. However, information about the current and potential distribution of Ae. koreicus is limited. Therefore, to understand the changes in their global distribution and to contribute to the monitoring and control of Ae. koreicus, in this study, the MaxEnt model was used to predict and analyze the current suitable distribution area of Ae. koreicus in the world to provide effective information.

Processing methods and the underlying detoxification mechanisms for toxic medicinal materials used by ethnic minorities in China: A review.

ETHNOPHARMACOLOGICAL RELEVANCE: Various toxic medicinal materials have been used by different ethnic minorities in China for thousands of years because of their extraordinary pharmacological activities. However, the improper use and complex toxicity-efficacy relationship could cause poisoning and even death. Therefore, the study of toxicity-attenuating methods and mechanisms is necessary. AIM OF THE STUDY: This review aims to summarize commonly used toxic ethnomedicines and their processing methods as well as the underlying mechanisms to potentially reduce toxicity and even enhance or preserve efficacy. Prospective for possible future investigations is also discussed. MATERIALS AND METHODS: Processing methods and mechanisms are investigated mainly through literature review. RESULTS: Processing methods with heating (boiling, stir frying, and steaming, etc.) and without heating (soaking) are usually used by Chinese ethnic minorities to attenuate the toxicity of ethnomedicines. Wheat bran, vinegar, wine, and herbal decoction are commonly used processing excipients. The mechanisms of detoxification by processing can be briefly summarized into three major categories: (1) direct elimination of impurities or reduction of toxic constituents' contents of ethnomedicines by cutting, washing, soaking or frosting; (2) chemical structure transformation of toxic constituents, such as alkaloids, glycosides, toxic proteins, animal toxicants, and mineral components, during heating and/or soaking; and (3) biological synergism or antagonism effects between the chemical constituents of processing excipients and ethnomedicines in vivo, to reduce toxicity and protect target organs. CONCLUSION: Toxic ethnomedicines have long been used in China, and detoxification by processing is the prerequisite for their safe clinical application. However, understanding on the special processing methods and detoxification mechanisms of ethnomedicines in China remains insufficient. Investigations on quality control of toxic ethnomedicines, as well as evaluation of processing methods and studies of the corresponding mechanisms should be further strengthened for safe and effective clinical application.

Aconitum pendulum and Aconitum flavum: A narrative review on traditional uses, phytochemistry, bioactivities and processing methods.

ETHNOPHARMACOLOGICAL RELEVANCE: Composed of dried Aconitum pendulum and Aconitum flavum roots, Tiebangchui, is an important Tibetan medicine and has been traditionally and widely used as a remedy for cold and pain for thousands of years because of its extraordinary pharmacological activities. The toxicity and efficacy of Tiebangchui as a typical toxic traditional Tibetan medicine, are interdependent, and thus to make sure its safe use in clinics is also noteworthy. AIM OF THE STUDY: This review aims to document and summarize critical and comprehensive information about traditional uses, phytochemistry, pharmacology, toxicology and processing methods of Tiebangchui. Perspectives for possible future investigations have been discussed. MATERIALS AND METHODS: Relevant information about Tiebangchui (A. pendulum and A. flavum) was collected from internationally recognized electronic scientific databases, such as Web of Science, PubMed, Science Direct, Springer Link, ACS, and CNKI. Then, classic Tibetan medical books, such as Four Medical Tantra, and Jing Zhu Materia Medica, and official drug standards were reviewed. RESULTS: A total of 95 chemical constituents have been isolated and identified from Tiebangchui, and most of them were diterpenoid alkaloids. These phytochemicals showed a wide range of pharmacological properties, such as anti-inflammation, anti-rheumatoid arthritis, analgesic, local anesthetic, anti-cancer and anti-bacterial activities. Hence, Tiebangchui is broadly used in hundreds of preparations to treat fever, arthritis, rheumatic arthralgia, traumatic injury, furuncle and swelling. Cardiotoxicity, neurotoxicity and gastrointestinal toxicity are the main toxic effects caused by the Aconitum alkaloids of Tiebangchui. Various processing methods, including steaming, decocting and sand-frying, and traditional Tibetan medicine processing methods, such as processing with Hezi decoction, Qingke wine and Zanba, are effective in attenuating toxicity while retaining efficacy. CONCLUSIONS: The present review provides primary information of Tiebangchui, particularly for its traditional uses, botanical characteristics, phytochemicals, outstanding bioactivities and processing methods. However, studies that explored the in vivo pharmacokinetics and mechanism of Tiebangchui, as well as its quality markers, qualitative and quantitative analysis are still insufficient. Processing methods that attenuate toxicities, evaluations of efficacy, in vivo processes and biological effects, the mechanisms of processed products should be further explored.

Assessment of effects of intra-abdominal pressure monitoring on evaluating early enteral nutrition in patients with acute pancreatitis / 中华危重病急救医学

Objective:To explore the role of intra-abdominal pressure (IAP) monitoring in evaluating the efficacy of early enteral nutrition (EN) in patients with acute pancreatitis (AP).Methods:The clinical data were collected from the AP patients in department of criticle care medicine of Baoshan Branch of Huashan Hospital Affiliated to Fudan University from July 2020 to June 2021. The patients were divided into three groups according to their treatments: no gastrointestinal decompression with fasting group, gastrointestinal decompression with fasting group, gastrointestinal decompression with indwelling jejunal tube within 24 hours group. The data of white blood cell (WBC), procalcitonin (PCT), serum amylase (AMY) and IAP were analyzed before and after treatment, the initiation time oral feeding were also analyzed.Results:The decrease of WBC, PCT, AMY, and IAP in gastrointestinal decompression with indwelling jejunal tube within 24 hours group were significantly greater than those in the other groups [WBC (×10 9/L): -1.72±0.74 vs. -0.68±0.36, -1.23±86.97; PCT (μg/L): -3.14±5.19 vs. 0.06±0.48, -1.57±0.78; AMY (U): -148.43±75.89 vs. -74.85±78.84, -93.78±1.17; IAP (cmH 2O, 1 cmH 2O≈0.098 kPa): -4.82±1.66 vs. 0.36±1.32, -3.22±4.36, all P < 0.05]. There were no correlation between the changes of IAP and the changes of WBC, PCT or AMY in the non-gastrointestinal decompression with fasting group and the gastrointestinal decompression with indwelling jejunal tube within 24 hours group (all P > 0.05). The decreasing trend of IAP in patients with gastrointestinal decompression with fasting group was positively correlated with the change of AMY ( r = 0.65, P < 0.001). The initiation time of oral feeding in gastrointestinal decompression with indwelling jejunal tube within 24 hours group was significantly shorter than that in the other groups (hours: 89.538 vs. 111.273, 109.714), the difference was statistically significant ( P < 0.05). Conclusions:IAP monitoring, as an emergency means of monitoring the efficacy of early EN in AP patients, has the advantages of simplicity, efficiency and rationality, which has a more objective basis than the previous empirical treatment and open oral feeding.

Effect of early intervention bundle on clinical prognosis of patients with latent/overt septic shock in emergency department / 中华危重病急救医学

Objective:To observe the effect of early intervention bundle on clinical prognosis of patients with latent/overt septic shock in emergency department and analyze the risk factors for mortality.Methods:Patients with latent and overt septic shock admitted to the North Hospital of Huashan Hospital Affiliated to Fudan University from January 2018 to December 2019 were retrospectively analyzed and divided into latent shock group and overt shock group. The gender, age, main infection site, the time of shock diagnosis, the indicators of early (3-hour) intervention bundle, 6-hour compliance rate of intervention bundle, the remission time and 28-day prognosis were observed. Logistic regression analysis was used to identify risk factors for 28-day mortality. Receiver operating characteristic (ROC) curve was used to analyze its prognostic value.Results:Totally 181 patients were included in the analysis. There were 102 cases in the latent shock group, and 28-day mortality was 15.69% (16 cases); 79 cases in the overt shock group, and 28-day mortality was 31.65% (25 cases). Compared with the latent shock group, patients in overt shock group had higher compliance rate of early intervention bundle (93.67% vs. 58.82%), higher blood lactate acid at admission [Lac (mmol/L): 7.09±2.08 vs. 5.69±1.27], higher compliance rate of blood culture before antibiotics (93.67% vs. 63.73%), higher proportion of antibiotics use at the first and second hours (45.57% vs. 31.37%, 54.43% vs. 33.33%), higher proportion of rapid fluid resuscitation at the first hour (crystal liquid: 59.49% vs. 11.76%, crystal fluid combined with human serum albumin: 40.51% vs. 0%), and higher proportion of vasoactive use at the first hour (100% vs. 9.80%). The stable time was significantly prolonged (days: 4.40±1.35 vs. 1.49±0.55), while the onset time (days: 1.47±0.97 vs. 2.95±1.61), the time of diagnosis (minutes: 31.30±12.54 vs. 79.15±13.81), 6-hour lactate clearance [(50.27±21.53)% vs. (61.82±13.12)%], the proportion of antibiotics use at the third hour (0% vs. 35.29%), the proportion of rapid fluid resuscitation at the second and third hour (second hour crystal liquid: 0% vs. 60.78%, second hour crystal fluid combined with human serum albumin: 0% vs. 14.71%, third hour crystal liquid: 0% vs. 12.75%), 6-hour compliance rate of the standard of central venous blood saturation (ScvO 2, 60.76% vs. 78.43%) and the success rate of treatment (28-day mortality: 31.65% vs. 15.69%) were lower than those of the latent shock group (all P < 0.05). Ten patients with latent shock developed into overt shock within 24 hours after admission. All patients with overt shock needed vasoactive drugs to maintain mean arterial pressure (MAP) ≥ 65 mmHg (1 mmHg = 0.133 kPa). Compared with the survival patients, the Lac (mmol/L: 7.59±2.27 vs. 5.92±1.24) and the proportion of vasoactive drugs use (65.85% vs. 44.29%) were significantly increased in the death patients, while the 6-hour lactate clearance [(46.58±15.83)% vs. (59.60±17.92)%], the proportion of antibiotics use in the third hour (4.88% vs. 24.29%), and 6-hour compliance rate of urine volume and ScvO 2 (56.10% vs. 82.86%, 43.90% vs. 78.57%) were significantly decreased (all P < 0.05). Binary Logistic regression analysis showed that Lac at admission, 6-hour lactate clearance, the use of antibiotics at the third hour, rapid fluid resuscitation at the first hour, and 6-hour compliance rate of ScvO 2 were independent risk factors for 28-day mortality [odds ratio ( OR) was 1.618, 0.021, 0.100, 0.307 and 3.018, all P < 0.05]. ROC curve analysis showed that the Lac at admission had the highest predictive value for 28-day mortality, the area under the ROC curve (AUC) was 0.706; followed by 6-hour compliance rate of ScvO 2 (AUC was 0.673). Conclusion:Patients with latent/overt septic shock need early diagnosis and intervention bundle to improve the 6-hour blood lactate clearance and 6-hour compliance rate of ScvO 2 and reduce the mortality.

Significance of the ratio of C-reactive protein to prealbumin in patients with traumatic brain injury / 中华危重病急救医学

Objective:To investigate the value of serum C -reactive protein/prealbumin ratio (CRP/PA) in predicting the disease progression of adult patients with traumatic brain injury. Methods:A prospective study was conducted. Patients with traumatic brain injury who were over 18 years old and were followed up for more than 72 hours admitted to the department of emergency of Huashan North Hospital Affiliated to Fudan University from May 2018 to December 2019 were enrolled. The levels of serum CRP, PA were measured immediately after injury and at 6, 24, 48 and 72 hours after injury, and the CRP/PA ratio was calculated. Glasgow coma score (GCS) was dynamically measured and head CT was reviewed regularly. If the GCS decreased by more than 3 and/or the intracranial injury was aggravated by CT scan within 72 hours after injury, the patients were included in the aggravating group. If there were no above changes, they were included in the stable group. The differences of each index between the two groups were compared, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each index at different time points on the patient's disease progress.Results:A total of 106 patients were selected, including 89 patients in the stable group and 17 patients in the aggravating group, and the baseline data of the two groups were balanced. CRP, CRP/PA increased and PA decreased in brain trauma patients 6 hours after injury, and reached the peak value or valley value at 48 hours. Compared with the stable group, CRP/PA significantly increased at 24, 48 and 72 hours in the aggravating group [24 hours: 34.18 (20.19, 67.10) vs. 13.98 (4.36, 38.30), 48 hours: 71.10 (45.55, 96.97) vs. 16.02 (5.05, 41.76), 72 hours: 23.25 (4.46, 38.61) vs. 4.72 (2.38, 12.95), all P < 0.05]. ROC curve analysis showed that CRP/PA ratio at 24 hours and 48 hours after injury could be used as a predictor of disease progression. The area under the ROC curve (AUC) of 24 hours CRP/PA was 0.71, 95% confidence interval (95% CI) was 0.58-0.84, the cut -off value was 28.29, the sensitivity was 76.5%, and the specificity was 73.0%. The AUC of 48 hours CRP/PA was 0.76, 95% CI was 0.62-0.90, and the cut -off value was 37.18, the sensitivity was 88.2%, and the specificity was 70.8%. Conclusion:The dynamic monitoring of CRP/PA ratio in adult after traumatic brain injury can evaluate the disease condition, and the CRP/PA ratio of 24 hours and 48 hours can predict the progress of the disease.

Design and implementation of an integrated information platform for emergency interconnection / 中华危重病急救医学

Objective To establish a "patient-centered" integrated information platform for emergency interconnection. Methods Based on the existing software, hardware and network systems of the hospital, design ideas of the modularization, process and standardized were used to reshape the process of emergency diagnosis and treatment in department of emergency-critical care medicine of Huashan North Hospital,Fudan University, and develop integrated information platform for emergency interconnection, including triage, emergency physician workstation, electronic medical records, clinical pathways of key diseases, medical integration, electronic handover classes, imaging, testing, ultrasound, drug counseling and medication safety, performance appraisal and management systems of scientific research, etc. Results The information platform for emergency interconnection was successfully developed. The functional logic of each system was clear and concise. It had strong compatibility, stable performance and powerful processing capability. It could quickly query the target content and support free and fast switching of each window. At present, daily diagnosis and treatment of emergency patients were realized by informationization, which completely liberated the manual labor of medical staff, shortened the processing time of unit patient, and significantly improved efficiency of the work. At the peak of the patients' visit, the overall operation of the emergency department was stable, and all the work was carried out in an orderly manner. There was no delay of the diagnosis and treatment for critically ill patients in the emergency department. Emergency access to patients with key diseases was smooth, and waiting time was significantly shortened. Clinical decision-making of medical staff had been effectively regulated. The success rates of the patients with acute trauma or acute respiratory failure were significantly improved, the time of the critical treatment were significantly shortened in patients with emergency respiratory cardiac arrest or acute ST-segment elevation myocardial, and compliance rate of the door-to-balloon time met the requirements of the Emergency Room to Balloon Expansion Time (DTB) Alliance. Conclusion The integrated information platform for emergency interconnection ran through the whole process of emergency diagnosis and treatment, based on emergency clinical practice, which could meet the needs of daily work in emergency department and help improve the quality of emergency medical and department management.

Clinical practice and evaluation of management of patients based on clinical pathway of emergency respiratory and cardiac arrest / 中华危重病急救医学

Objective To explore the effect of clinical pathway of emergency respiratory and cardiac arrest on management of patients with sudden respiratory and cardiac arrest. Methods The clinical data of patients with sudden respiratory and cardiac arrest admitted to Huashan North Hospital Affiliated to Fudan University from 1 year before to 1 year (started in July 2017) after the implementation of clinical pathway of emergency respiratory and cardiac arrest were retrospectively analyzed. The patients who managed by clinical pathway of emergency respiratory and cardiac arrest (from July 2017 to June 2018) were served as observational group, and those manually managed by 2015 American Heart Association cardiopulmonary resuscitation and cardiovascular emergency guide update and the procession in the management of emergency key diseases (from July 2016 to June 2017) were set as control group. The gender, age, underlying disease, the initiation time of cardiopulmonary resuscitation (CPR), the first time of defibrillation, the completion time of endotracheal intubation, the time of venous access, the usage time of the first dose of adrenaline, the usage time of vasoactive drugs, the completion rate of high quality CPR, the success rate of return of spontaneous circulation (ROSC) and the table procedure of clinical pathway were compared between the two groups. Results There was no statistically significant difference in gender, age or underlying disease between the two groups. Compared with the control group, the clinical pathway could effectively guide the decision-making of the emergency medical staffs, significantly reduce the variation in the procession of the resuscitation, the first time of defibrillation, the completion time of the deep vein catheterization, the usage time of norepinephrine and the completion time of the blood specimen delivery were significantly shortened [the first time of defibrillation (minutes): 1.28±0.86 vs. 2.93±1.61, the completion time of deep vein catheter (minutes): 15.13±2.73 vs. 17.25±3.02, the usage time of norepinephrine (minutes): 15.43±2.80 vs. 17.88±1.67, the completion time of blood specimen delivery (minutes): 7.81±1.42 vs. 9.00±1.03, all P < 0.05]. There was no statistically significant difference in the initiation time of CPR, the completion time of tracheal intubation, the time of peripheral venous access, the usage time of the first dose of adrenaline or sodium bicarbonate, or the success rate of ROSC between the two groups. However, the usage time of the first dose of adrenaline and sodium bicarbonate was shortened in the observation group [the usage time of the first dose of adrenaline (minutes): 3.81±1.22 vs. 4.00±1.32, the usage time of the first does of sodium bicarbonate (minutes): 8.94±3.49 vs. 11.19±3.54, both P > 0.05], and the success rate of ROSC was relatively increased as compared with those in the control group [15.04% (17/113) vs. 12.50% (12/96), P > 0.05]. Conclusion The clinical pathway of emergency respiratory and cardiac arrest could effectively guide the clinical decision-making of the emergency medical staffs, significantly reduce the variation in the procession of the resuscitation, improve the quality of the resuscitation, and ensure medical safety of emergency department.

Analysis on distribution and drug resistance of pathogen caused community-onset bloodstream infection / 中华危重病急救医学

Objective To investigate the distribution and drug resistance of pathogen caused community-onset bloodstream infection (COBSI) in patients of affiliated hospital of university,and to provide evidence for the clinical therapy.Methods The clinical data of patients with COBSI in emergency department admitted to Huashan North Hospital Affiliated to Fudan University from January 2014 to December 2017 were collected,and the distribution and drug resistance of pathogen were retrospectively analyzed.The patients were divided into community-acquired bloodstream infection (CABSI) group and health care-associated bloodstream infection (HCABSI) group according to clinical diagnosis.The source of patients,past health status,blood culture isolation of pathogens,drug sensitivity test results were recorded,and the trend of drug resistance of main pathogens to common antibiotics from 2014 to 2017 were analyzed.Results A total of 258 pathogens were isolated from patients,including 186 Gram-negative pathogens (G-pathogens,72.09％) and 72 Gram-positive pathogens (G+ pathogens,27.91％),while the fungal strain was not isolated.The two most frequently isolated G-pathogens causing CABSI were Escherichia coli (80 isolates,65.57％) and Klebsiella pneumonia (24 isolates,19.67％),including extended-spectrum beta-lactamases (ESBLs)-producing Escherichia coli (37 isolates) and Klebsiella pneumonia (3 isolates),the average detection rates were 46.25％ and 12.50％ respectively.The two most frequently isolated G+ pathogens were Streptococcus (32 isolates,57.14％) and Staphylococcus (15 isolates,26.79％),but methicillin-resistant Staphylococcus aureus (MRSA) had not been isolated.The two most frequently isolated G-pathogens causing HCABSI were Escherichia coli (45 isolates,70.32％) and Klebsiella pneumonia (7 isolates,10.94％),including ESBLs-producing Escherichia coli (20 isolates) and Klebsiella pneumonia (1 isolate),the average detection rate was 44.44％ and 14.29％,respectively.The most frequently isolated G+ pathogens were Staphylococcus (10 isolates,62.50％),Streptococcus (3 isolates,18.75％) and Enterococcus faecium (3 isolates,18.75％),including MRSA (3 isolates).ESBLs-positive Escherichia coli and Klebsiella pneumoniae were almost completely resistant to cefazolin and highly resistant to ampicillin,ampicillin sodium and sulbactam sodium,ceftriaxone and furadantin,with the drug resistance rates of higher than 50％,and the drug resistance rate was significantly higher than that of corresponding ESBLs-producing negative pathogens.Escherichia coli were completely sensitive to piperacillin tazobactam,imipenem,and ertapenem,but Klebsiella pneumoniae had some resistance to piperacillin tazobactam and imipenem.Methicillinresistant coagulase-negative Staphylococci (MRCNS) were highly resistant to common antibiotics,while Streptococcus strains and MRSA had low resistance rates,and all pathogens were completely sensitive to linezolid and vancomycin.The average annual resistance rate of Escherichia coli to common antibiotics in CABSI group was increased,but the difference was significant only for ciprofloxacin (from 2014 to 2017,they were 37.5％,28.6％,52.6％,65.2％,respectively,Z =5.076,P =0.024).The average annual resistance rate of Klebsiella pneumonia to cefazolin and ciprofloxacin in CABSI group and that of Escherichia coli to ceftriaxone in HCABSI group showed an increasing trend without significant differences.Conclusions Escherichia coli and Klebsiella pneumoniae were the main pathogens of emergency COBSI,ESBLs-producing Escherichia coli were more common,and the average annual drug resistance rate to common clinical antibiotics was increasing.The drug resistance of ESBLs-producing Escherichia coli and Klebsiella pneumoniae was more serious than that of ESBLs-producing negative pathogens,so antibiotics should be used rationally.

Clinical practice and evaluation of management of patients based on clinical pathway of emergency respiratory and cardiac arrest / 中华危重病急救医学

OBJECTIVE@#To explore the effect of clinical pathway of emergency respiratory and cardiac arrest on management of patients with sudden respiratory and cardiac arrest.@*METHODS@#The clinical data of patients with sudden respiratory and cardiac arrest admitted to Huashan North Hospital Affiliated to Fudan University from 1 year before to 1 year (started in July 2017) after the implementation of clinical pathway of emergency respiratory and cardiac arrest were retrospectively analyzed. The patients who managed by clinical pathway of emergency respiratory and cardiac arrest (from July 2017 to June 2018) were served as observational group, and those manually managed by 2015 American Heart Association cardiopulmonary resuscitation and cardiovascular emergency guide update and the procession in the management of emergency key diseases (from July 2016 to June 2017) were set as control group. The gender, age, underlying disease, the initiation time of cardiopulmonary resuscitation (CPR), the first time of defibrillation, the completion time of endotracheal intubation, the time of venous access, the usage time of the first dose of adrenaline, the usage time of vasoactive drugs, the completion rate of high quality CPR, the success rate of return of spontaneous circulation (ROSC) and the table procedure of clinical pathway were compared between the two groups.@*RESULTS@#There was no statistically significant difference in gender, age or underlying disease between the two groups. Compared with the control group, the clinical pathway could effectively guide the decision-making of the emergency medical staffs, significantly reduce the variation in the procession of the resuscitation, the first time of defibrillation, the completion time of the deep vein catheterization, the usage time of norepinephrine and the completion time of the blood specimen delivery were significantly shortened [the first time of defibrillation (minutes): 1.28±0.86 vs. 2.93±1.61, the completion time of deep vein catheter (minutes): 15.13±2.73 vs. 17.25±3.02, the usage time of norepinephrine (minutes): 15.43±2.80 vs. 17.88±1.67, the completion time of blood specimen delivery (minutes): 7.81±1.42 vs. 9.00±1.03, all P < 0.05]. There was no statistically significant difference in the initiation time of CPR, the completion time of tracheal intubation, the time of peripheral venous access, the usage time of the first dose of adrenaline or sodium bicarbonate, or the success rate of ROSC between the two groups. However, the usage time of the first dose of adrenaline and sodium bicarbonate was shortened in the observation group [the usage time of the first dose of adrenaline (minutes): 3.81±1.22 vs. 4.00±1.32, the usage time of the first does of sodium bicarbonate (minutes): 8.94±3.49 vs. 11.19±3.54, both P > 0.05], and the success rate of ROSC was relatively increased as compared with those in the control group [15.04% (17/113) vs. 12.50% (12/96), P > 0.05].@*CONCLUSIONS@#The clinical pathway of emergency respiratory and cardiac arrest could effectively guide the clinical decision-making of the emergency medical staffs, significantly reduce the variation in the procession of the resuscitation, improve the quality of the resuscitation, and ensure medical safety of emergency department.

The expression of P120 catenin in pancreatic carcinoma and the relationship between the T755G polymorphism of P120 catenin gene and pancreatic carcinoma / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the expression of P120 catenin in pancreatic carcinoma and to explore the association between P120 catenin gene polymorphism at T755G position and pancreatic carcinoma.</p><p><b>METHODS</b>The expression of P120 catenin in 52 cases of pancreatic carcinoma and normal pancreatic tissues on the mRNA and protein levels were evaluated by RT-PCR and Western Blot methods respectively. P120 catenin gene polymorphism at T755G position of in 52 patients and 60 healthy controls were examined by PCR-restriction fragment length polymorphism (PCR-RFLP) technique.</p><p><b>RESULTS</b>The mRNA and protein expressions of P120 catenin in pancreatic carcinoma tissues were significantly lower than normal pancreatic tissues (P=0.000, P=0.002). Reduced expression of P120 catenin mRNA was significantly correlated with differentiated (P=0.033), lymph node metastasis (P=0.004), vascular invasion (P=0.022), and pTNM stage (P=0.003). Additionally, there were significant difference of P120 catenin gene polymorphism genotypes and alleles at T755G position between patients and healthy controls (P=0.008, P=0.016). The GG genotype of P120 catenin gene was associated with higher risk of incidence for pancreatic carcinoma compared with the TT genotype (OR=2.765, 95%CI=1.312-3.958).</p><p><b>CONCLUSIONS</b>The reduced expressions of both P120 catenin mRNA and protein in pancreatic carcinoma suggest its association with pancreatic carcinoma development. Polymorphism of P120 catenin gene at T755G situation might be a risk factor for pancreatic carcinoma, and it may be used to diagnosis and prevent pancreatic carcinoma early.</p>

Effects of lentiviral-delivered CDC25B2 siRNA on biological behaviors of human pancreatic cancer cell line CFPAC-1 / 国际肿瘤学杂志

Objective To establish CFPAC-1 cell lines deficient in CDC25B2 by recombinant lentivirus, and to investigate the role of this gene. Methods After CFPAC-1 cells were transduced with recombinant lentivirus producing CDC25B2 siRNA, stably transduced cells with green fluorescent protein were selected by flow cytometer. The mRNA and protein expression of CDC25B2 was examined by RT-PCR and Western blot analysis. The effect of the lentivirus on the cell proliferation, cell cycle, clone-forming, migration and invasion ability was analyzed by MTr method, flow cytometer, plate clone-forming assay and Transwell chamber method respectively. Results CDC25B2 siRNA knocked down CDC25B2 expression in CFPAC-1 cells significantly. The silencing efficiency of siRNA transduction by recombinant lentivirns was very high. Proliferation, cloneforming, migration and invasion ability of human pancreatic cancer cell line CFPAC-I were significantly in-creased, while cell cycle was not affected. Conclusion CDC25 B2 plays an important role in cell proliferation, clone-forming, migration and invasion of pancreatic cancer. This research provides experimental evidences for targeting CDC25B2 in gene therapy against pancreatic cancer.

THE MAIN DISTRIBUTION OF ENDOGENOUS PEROXIDASE IN THE RAT BRAIN / 解剖学报

Horseradish peroxidase (HRP) has been curently used for tracing the interrelationship between neurons in peripheral and central nervnos system. In order to differentiate endo-and exogenous peroxidases, 15 adult, healthy rats were selected for investigating the distribution of endogenous peroxidase in tissues. Fresh cryostat frozen sections of brain were fixed in fixatives of various concentrations and PH, and sections were made after perfusion of the fixative through heart. They were incubated in media containing DAB and hydrogenperoxide. Potassium cynide or sodium azide was used as inhibitators.The reaction of peroxidase in medula oblongata, pons, midbrain, thalamus, hypothamus, hippocampus and striatum etc were studied with dark field and transmitted light microscope. In the superficial layer of the Ⅲ and Ⅳ ventricles and periaqueductal gray substance of midbrain, there were large number of dark brown peroxidase granules with non neuronal distribution.The peroxidase granules were found in the entire or the dorasal part of locus ceruleus, the ventral part of cerebellum and the dorasal part of hippocampus. Small amount of granules were located in medial nucleus of habenularis, stria medullaris, nucleus supraopticus hypothalami and suprachiasmaticus. Large amount of positive reactive granules were found in nucleus arcuate. Some of them were localized in the perineurons of polydendritic neurons but most of them were of nonneuronal distribution. Sparse granules were also observed in the dorsomedial part of nucleus caudatus putamen and dorsal part of nucleus septicus lateralis. In commisure fornix and corpus callosum, the granules were distributed along the nerve fiber bundle. There were large amount of positive reactive granules around the subfornix organ especially on its dorsal part. To sum up, the main distribution of them are periventricular, periaqueductal gray substance and periventricular organs (such as area postrema, locus coeruleus, nucleus arcuata, subfonix organ and several neurosecretory nuclei of hypothalamus). It seems that the distribution of this enzymes might be closely related to synthesis, metabolism and release of the neurosecretion or transmitters of these nuclei and some of them might act through the cerebro-spinal fluid.

A COMPARATIVE HISTOCHEMICAL STUDY OF THE EFFECT OF ACUPUN CTURE AND MORPHINE ON THE LOCUS COERULEUS AND DORSAL RAPHE NUCLEUS / 解剖学报

Based upon our previous experiments of acupuncture analgesia, morphine was adopted for comparison with acupuncture analgesia. Ninty four healthy, adult, male rats were divided into three groups: Two morphine(2,10 mg/kg) and one control group. The pain threshold of 10mg/kg morphine group was similar to that of the acupuncture analgesia; that of the 2mg/kg morphine group varied a great deal individually. Another group of 86 rats were selected and divided into three groups: effective acupuncture group, morphine (10mg/kg) group, and the control. After the measurement of pain threshold, the amount of AChE of the locus coeruleus of the animals was measured with a microphotometer. The ACHE reaction of acupuncture group was significantly increased in comparison with the control as well as with the morphine group. That of morphine group was weaker than the control, though without statistical significance. The number of AChE positive cells in nucleus raphe dorsalis of the acupunctured rats was significantly increased, while no significant difference existed between that of the control and morphine groups.The results showed that both acnpuncture and morphine produced effective analgesia. The former seemed, however, to act upon certain nuclei of the central nervous system possibly through the activities of their enzymes. Neurotransmitters may take active part in analgesia and probably a functional regulation of the organism is involved.

A MICROELECTROPHORETIC DELIVERY OF HORSERADISH PEROXIDASE FOR DEMONSTRATING THE AFFERENT PROJECTION TO NUCLEUS RAPHE MAGNUS / 解剖学报

20 adult healthy rats were used for microelectropheretic delivery of horseradish peroxidase (HRP). The diameter of the tip of the glass electrode was around 20～50?. It was inserted into nucleus raphe magnus, 20% HRP was delivered microelectrophoretically(5 ?A for 30 min; 10 ?A for 10 min). In eight rats the microelectrode was withdrawn immediately after the delivery and in the rest it was removed 10～20 minutes after delivery. Afterward the animals were allowed to survive for 40 hrs before decapitation, except 2 for 20 and 2 for 60 hrs. The brains were dissected out for cryostat sections and DAB reaction for peroxidase.The tip of the electrode was located in the nucleus raphe magnus, at the level of nucleus facialis. The diameter of the brain tissues occupied by HRP at the points of microelectophoretic delivery was 0.2～0.4mm and the maximum reached 0.6～0.7mm. The exogenous HRP granules were not visible in the cases with electrodes withdrawn immeditely after delivery and in the survivors of 60 hrs. In most cases the electrodes were left inside for more than 10 minutes after the delivery. The exogenous HRP granules were large, coarse, brown, steroscopic and distributed evenly in the perikaryon of some neurons in several levels of the brain. Those in the axon and dentrite were distributed just like strings of pearls. There were much more neurons with exogenous HRP positive granules dispersed in the reticular formation of the medula oblongata, most of them were polydendritic. Small and fusiformed HRP-positive cells are observed occasionally in the gray substance of subventriculum, reticular formation pontis and ventrolateral side of locus coeruleus. Weaker reactions were found in a few cells in the periaquaductous gray substance of the midbrain, nucleus raphe centro-superior, substantia nigra pars compacta and in the area around the nucleus supraopticus. Besides no HRP-positive cells were discovered in thalamus and subcortex structure.There were two types of cells with HRP positive granules around some blood vessels in reticular formation and subventricular gray substance: One was a small protoplasmic astrocyte with broad cytoplasma, small nucleus, and thick, short and irregular processes and another kind was polydendritic neurons filling with brown positive granules in perikarya and cytoprocesses, in the latter, the HRP positive granules were arranged as strips of pearls.