Comparison of Clinical Effectiveness Between Ambroxol and N-Acetylcysteine in Surgical Patients: A Retrospective Cohort Study.

Postoperative pulmonary complications (PPCs) are a major cause of postoperative morbidity, mortality, and longer hospital stays. Expectorants are widely used during the perioperative period to reduce PPCs. This study aimed to compare the clinical effectiveness between ambroxol (AMB) and N-acetylcysteine (NAC) in patients undergoing surgery. A multicenter, retrospective cohort study was conducted using deidentified medical records from hospital information system. Between July 1, 2015, and November 30, 2017, patients aged ≥18 years, who received intravenous AMB or nebulized NAC as the only expectorant therapy for >3 days during their hospitalization for thoracic, abdominal, and neurosurgery, were included in this study. The clinical outcomes were evaluated, and propensity score matching was used to adjust significant differences between 2 groups. A total of 4025 cases in the AMB group and 2062 in NAC group after propensity score matching were identified. The incidence of PPCs (13.9% vs 11.6%; P = .013), postoperative sputum suction (17.2% vs 8.0%; P < .001), intensive care unit admission after surgery (25.1% vs 22.5%; P = .024), and postoperative mechanical ventilation (22.3% versus 17.5%; P < .001) in the AMB group were all significantly higher than those in the NAC group. This study suggested that patients treated with NAC during the perioperative period had a significantly lower risk of PPCs. However, further prospective study is needed to ensure the replicability of our findings.

Antibiotic Prescriptions among China Ambulatory Care Visits of Pregnant Women: A Nationwide Cross-Sectional Study.

BACKGROUND: Antibiotic use in pregnant women at the national level has rarely been reported in China. OBJECTIVES: We aimed to investigate antibiotic prescriptions during pregnancy in ambulatory care settings in China. METHODS: Data of 4,574,961 ambulatory care visits of pregnant women from October 2014 to April 2018 were analyzed. Percentages of Antibiotic prescriptions by different subgroups and various diagnosis categories and proportions of inappropriate antibiotic prescriptions for different subgroups were estimated. Food and Drug Administration (FDA) pregnancy categories were used to describe the antibiotic prescription patterns. The 95% confidence intervals (CIs) were estimated using the Clopper--Pearson method or Goodman method. RESULTS: Among the 4,574,961 outpatient visits during pregnancy, 2.0% (92,514 visits; 95% CI, 2.0-2.0%) were prescribed at least one antibiotic. The percentage of antibiotic prescriptions for pregnant women aged >40 years was 4.9% (95% CI, 4.7-5.0%), whereas that for pregnant women aged 26-30 years was 1.5% (95% CI, 1.4-1.5%). In addition, percentages of antibiotic prescriptions varied among different trimesters of pregnancy, which were 5.4% (95% CI, 5.3-5.4%) for the visits in the first trimester of pregnancy and 0.5% (95% CI, 0.4-0.5%) in the third trimester of pregnancy. Furthermore, the percentages of antibiotic prescriptions substantially varied among different diagnosis categories and nearly three-quarters of antibiotic prescriptions had no clear indications and thus might be inappropriate. In total, 130,308 individual antibiotics were prescribed; among these, 60.4% (95% CI, 60.0-60.8%) belonged to FDA category B, 2.7% (95% CI, 2.1-3.5%) were classified as FDA category D and 16.8% (95% CI, 16.2-17.4%) were not assigned any FDA pregnancy category. CONCLUSIONS: Antibiotic prescriptions in ambulatory care during pregnancy were not highly prevalent in mainland China. However, a substantial proportion of antibiotics might have been prescribed without adequate indications. Antibiotics whose fetal safety has not been sufficiently illustrated were widely used in pregnant women.

Design and Fabrication of a MEMS Electromagnetic Swing-Type Actuator for Optical Switch.

A microelectromechanical systems system (MEMS) electromagnetic swing-type actuator is proposed for an optical fiber switch in this paper. The actuator has a compact size of 5.1 × 5.1 × 5.3 mm3, consisting of two stators, a swing disc (rotator), a rotating shaft, and protective covers. Multi-winding stators and a multipole rotator were adopted to increase the output torque of the actuator. The actuator's working principle and magnetic circuit were analyzed. The calculation results show that the actuator's output torque is decisive to the air gap's magnetic flux density between the stators and the swing disc. NiFe alloy magnetic cores were embedded into each winding center to increase the magnetic flux density. A special manufacturing process was developed for fabricating the stator windings on the ferrite substrate. Six copper windings and NiFe magnetic cores were electroplated onto the ferrite substrates. The corresponding six magnetic poles were configured to the SmCo permanent magnet on the swing disc. A magnetizing device with a particular size was designed and fabricated to magnetize the permanent magnet of the swing disc. The actuator prototype was fabricated, and the performance was tested. The results show that the actuator has a large output torque (40 µNm), fast response (5 ms), and a large swing angle (22°).

Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database study.

BACKGROUND: Inappropriate antibiotic use greatly accelerates antimicrobial resistance. The appropriateness of antibiotic prescriptions is well evaluated, using big observational data, in some high-income countries, whereas the evidence of this appropriateness is scarce in China. We aimed to assess the appropriateness of antibiotic prescriptions in ambulatory care settings in China to inform future antimicrobial stewardship. METHODS: We used data from the Beijing Data Center for Rational Use of Drugs, which was a national database designed for monitoring rationality of drug use. 139 hospitals that uploaded diagnosis and prescription information were included from 28 provincial-level regions of mainland China. Outpatient prescriptions were classified as appropriate, potentially appropriate, inappropriate, or not linked to any diagnosis for antibiotic use by following a published classification scheme. Antibiotic prescription rates for various diagnosis categories and proportions of inappropriate antibiotic prescriptions for different subgroups were estimated. Antibiotic prescribing patterns and proportions of individual antibiotics prescribed for different diagnosis categories were analysed and reported. FINDINGS: Between Oct 1, 2014, and April 30, 2018, 18 848 864 (10·9%) of 172 704 117 outpatient visits ended with antibiotic prescriptions. For conditions for which antibiotic use was appropriate, potentially appropriate, and inappropriate, 42·2%, 30·6%, and 7·6% of visits were associated with antibiotic prescriptions, respectively. Of all 18 848 864 antibiotic prescriptions, 9 689 937 (51·4%) were inappropriate, 5 354 224 (28·4%) were potentially appropriate, 2 893 102 (15·3%) were appropriate, and 911 601 (4·8%) could not be linked to any diagnosis. A total of 23 266 494 individual antibiotics were prescribed, of which 18 620 086 (80·0%) were broad-spectrum and the top four most prescribed antibiotics were third-generation cephalosporins (5 056 058 [21·7%]), second-generation cephalosporins (3 823 410 [16·4%]), macrolides (3 554 348 [15·3%]), and fluoroquinolones (3 285 765 [14·1%]). INTERPRETATION: Inappropriate antibiotic prescribing was highly prevalent nationwide in China. Over half of the antibiotic prescriptions were inappropriate in secondary-level and tertiary-level hospitals, suggesting an urgent need for outpatient antibiotic stewardship aimed at optimising antibiotic prescribing to achieve the goals set in China's 2016 national action plan to contain antimicrobial resistance. FUNDING: The National Natural Science Foundation of China.

Outpatient antibiotic use associated with acute upper respiratory infections in China: a nationwide cross-sectional study.

BACKGROUND: The assessment of antibiotic use for acute upper respiratory infections (AURIs) is important to promote the appropriateness of antibiotic prescribing. Evaluation of antibiotic prescriptions for AURIs at a national level is very limited in China. OBJECTIVE: To investigate outpatient antibiotic prescriptions for AURIs in Chinese hospitals. METHODS: This study used data from over 10 million outpatient and emergency department visits for AURIs, which contained information on drug prescription and diagnosis, from 94 cities and 28 provinces of mainland China. Antibiotic prescription rates for various subgroups and potential predictors of antibiotic use were estimated. Patterns of antibiotic prescriptions and proportions of individual antibiotics prescribed for different types of AURIs were analysed and reported. RESULTS: In total, 10 770 219 outpatient visits for AURIs were included in this study. Of these, 40.8% (95% confidence interval 40.7-40.8%) resulted in antibiotic prescriptions. Patient characteristics, including age, gender, payment type, AURI type, department and season of visit, were significantly associated with antibiotic prescriptions for AURIs. In total, 4 984 744 antibiotic agents were prescribed, of which 87.9% were broad-spectrum antibiotics and only 36.8% were prescribed in line with the guideline recommendations. Azithromycin (13.2%), cefdinir (11.7%), cefixime (8.3%) and cefaclor (8.2%) were the most commonly prescribed antibiotics for AURIs in China. CONCLUSIONS: Antibiotic prescribing for patients with AURIs in outpatient settings was prevalent nationwide in China. Antibiotic stewardship efforts targeting specific populations in outpatient settings are needed to reduce antibiotic use and promote appropriate antibiotic selection for AURIs in China.

Validation of an algorithm to evaluate the appropriateness of outpatient antibiotic prescribing using big data of Chinese diagnosis text.

OBJECTIVE: We aimed to evaluate the validity of an algorithm to classify diagnoses according to the appropriateness of outpatient antibiotic use in the context of Chinese free text. SETTING AND PARTICIPANTS: A random sample of 10 000 outpatient visits was selected between January and April 2018 from a national database for monitoring rational use of drugs, which included data from 194 secondary and tertiary hospitals in China. RESEARCH DESIGN: Diagnoses for outpatient visits were classified as tier 1 if associated with at least one condition that 'always' justified antibiotic use; as tier 2 if associated with at least one condition that only 'sometimes' justified antibiotic use but no conditions that 'always' justified antibiotic use; or as tier 3 if associated with only conditions that never justified antibiotic use, using a tier-fashion method and regular expression (RE)-based algorithm. MEASURES: Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the classification algorithm, using classification made by chart review as the standard reference, were calculated. RESULTS: The sensitivities of the algorithm for classifying tier 1, tier 2 and tier 3 diagnoses were 98.2% (95% CI 96.4% to 99.3%), 98.4% (95% CI 97.6% to 99.1%) and 100.0% (95% CI 100.0% to 100.0%), respectively. The specificities were 100.0% (95% CI 100.0% to 100.0%), 100.0% (95% CI 99.9% to 100.0%) and 98.6% (95% CI 97.9% to 99.1%), respectively. The PPVs for classifying tier 1, tier 2 and tier 3 diagnoses were 100.0% (95% CI 99.1% to 100.0%), 99.7% (95% CI 99.2% to 99.9%) and 99.7% (95% CI 99.6% to 99.8%), respectively. The NPVs were 99.9% (95% CI 99.8% to 100.0%), 99.8% (95% CI 99.7% to 99.9%) and 100.0% (95% CI 99.8% to 100.0%), respectively. CONCLUSIONS: The RE-based classification algorithm in the context of Chinese free text had sufficiently high validity for further evaluating the appropriateness of outpatient antibiotic prescribing.

Recent Progress on Electromagnetic Field Measurement Based on Optical Sensors.

Electromagnetic field sensors are widely used in various areas. In recent years, great progress has been made in the optical sensing technique for electromagnetic field measurement, and varieties of corresponding sensors have been proposed. Types of magnetic field optical sensors were presented, including probes-based Faraday effect, magnetostrictive materials, and magnetic fluid. The sensing system-based Faraday effect is complex, and the sensors are mostly used in intensive magnetic field measurement. Magnetic field optical sensors based on magnetic fluid have high sensitivity compared to that based on magnetostrictive materials. Three types of electric field optical sensors are presented, including the sensor probes based on electric-optic crystal, piezoelectric materials, and electrostatic attraction. The majority of sensors are developed using the sensing scheme of combining the LiNbO3 crystal and optical fiber interferometer due to the good electro-optic properties of the crystal. The piezoelectric materials-based electric field sensors have simple structure and easy fabrication, but it is not suitable for weak electric field measurement. The sensing principle based on electrostatic attraction is less commonly-used sensing methods. This review aims at presenting the advances in optical sensing technology for electromagnetic field measurement, analyzing the principles of different types of sensors and discussing each advantage and disadvantage, as well as the future outlook on the performance improvement of sensors.

Phosphatidylethanolamine-binding protein is not involved in µ-opioid receptor-mediated regulation of extracellular signal-regulated kinase.

Stimulation of the µ­opioid receptor activates extracellular signal­regulated kinase (ERK), however, the mechanism by which this occurs remains to be elucidated. Phosphatidylethanolamine­binding protein (PEBP) has been reported to act as a negative regulator of the ERK cascade (Raf­MEK­ERK) by binding to Raf­1 kinase. In the present study, the role of PEBP in µ­opioid receptor­mediated ERK activation was investigated in Chinese hamster ovary/µ cells and SH­SY5Y cells, as well as in human embryonic kidney 293 cells expressing other types of G protein­coupled receptors. The acute activation of µ­opioid receptors by morphine or (D­Ala2, MePhe4, Gly5­ol) enkephalin induced a rapid activation of ERK. Prolonged morphine treatment did not affect the phosphorylation level of ERK compared with control cells, but the phosphorylation level of ERK decreased markedly when cells were precipitated with naloxone following chronic morphine treatment. For the phosphorylation of PEBP, no change was identified under the designated drug treatment and exposure duration. A total of two other types of G protein­coupled receptors, including Gs­coupled dopamine D1 receptors and Gq­coupled adrenergic α1A receptors were also investigated and only the activation of adrenergic α1A receptors induced an upregulated phosphorylation of PEBP, which was protein kinase C activity dependent. Thus, PEBP did not have a significant role in µ­opioid receptor­mediated regulation of ERK.

[Roles of phosphatidylethanolamine-binding protein in cell signaling and its biological functions].

Phosphatidylethanolamine-binding protein (PEBP) is a cytoplasm soluble protein with a high conserved structure. It has been approved recently that PEBP is a multifunctional molecule regulating several important cellular signal pathways, including ERK cascade, NF-κB pathway, and signaling of G protein-coupled receptors. Furthermore, the role of PEBP in tumor metastasis also got a comprehensive attention in the field of clinical cancer research. Together, as a signal regulator at multiple paths in cell, PEBP is becoming a new focus in several research fields. This review is aimed to introduce the newest biological progress on PEBP.

Involvement of hippocampal phosphatidylethanolamine-binding protein in morphine dependence and withdrawal.

Drug addiction is thought to result from an intractable and aberrant learning and memory in response to drug-related stimulation, and cholinergic neurotransmission plays an important role in this process. Phosphatidylethanolamine-binding protein (PEBP) is the precursor of the hippocampal cholinergic neurostimulating peptide (HCNP), an 11 amino acid peptide that enhances the production of choline acetyltransferase (ChAT) and assists in the development of cholinergic projections from the medial septal nuclei to the hippocampus. However, whether PEBP is involved in drug addiction remains unclear. In the present study, PEBP expression in the hippocampus, as detected by proteomics analysis, was found to be dramatically up-regulated after rats received chronic morphine treatment. Western blotting analysis revealed a specific up-regulation of PEBP expression in the hippocampus but not in any other brain regions assessed. A down-regulation of hippocampal PEBP levels induced by antisense oligodeoxynucleotides resulted in aggravated morphine dependence. Together, these findings indicate that PEBP is involved in morphine dependence. Moreover, the time course of PEBP expression changes and ChAT activity was investigated during chronic morphine treatment and withdrawal. The results showed that the hippocampal PEBP levels were up-regulated during chronic morphine treatment and returned to the baseline 3 days after withdrawal, after which PEBP levels were persistently up-regulated for 28 days after withdrawal. The changes in hippocampal ChAT activity followed a pattern that was similar to that of the PEBP levels. Taken together, these results suggest that hippocampal PEBP is involved in morphine dependence and withdrawal, perhaps through modulating cholinergic transmission in the hippocampus.

Hyper-phosphorylation of GSK-3ß: possible roles in chlorpyrifos-induced behavioral alterations in animal model of depression.

In recent years, the widespread use of chlorpyrifos (CPF) has aroused concerns regarding its potential neurotoxic effects, especially in developing individuals. One of the major consequences of CPF exposure is mood disorders such as depression. Epidemiological studies have demonstrated susceptibility to depression in populations with a history of CPF exposure. Our previous study indicated that repeated CPF exposure in doses from 10 to 160 mg/kg elicits depression- and anxiety-like alterations. However, whether this alteration is due to persistent inhibition of acetylcholinesterase (AChE) was not determined. In this study, we used lower doses of CPF to avoid evident inhibition of AChE to investigate other potential target systems that contribute to CPF's neurotoxic effect. Four-week-old adolescent male rats were repeatedly exposed to CPF at doses of 2.5, 5, or 10mg/kg (s.c., 10 days) and then were subjected to either neurobehavioral testing or immunoblot analysis. Depression-like behaviors as manifested by increased immobility time was observed in force swimming test, while immunoblot analysis revealed a dramatically increased phosphorylation of glycogen synthase kinase-3ß (GSK-3ß) in the hippocampus and striatum, with no effect on the levels of Wnt2, GSK-3ß, or ß-catenin. These results suggest a noncholinergic mechanism, the hyper-phosphorylation of GSK-3ß, which may contribute to the cellular neurotoxicity of CPF, thus increasing the susceptibility to mood disorders.

[Clinical analysis of cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation].

The objective of this study was to explore the incidence and therapeutic efficacy of cytomegalovirus (CMV) infection after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The clinical data of 140 patients undergoing allo-HSCT in our department of hematology from 2010-01 to 2012-01 were retrospectively analyzed. The results showed that the incidence of CMV infection was 4.3% (48/140), the time for the first detection of positive CMV-DNA was at day 45 (33 to 68) after allo-HSCT, and the CMV quantitative range was 1.25×10(3) - 5.5×10(6). There were 2 cases of CMV-related interstitial pneumonia and 5 cases of hemorrhagic bladder inflammation. A total of 65 patients suffered from graft versus host disease (GVHD), in which 32 cases (49.2%) were accompanied with CMV infection, CMV-DNA negative in patients treated with ganciclovir, foscarnet sodium anti-CMV was at day 45 (33 to 68) with the effective rate of 100%. 12 patients with CMV infection were accompanied with transient neutropenia and thrombocytopenia. It is concluded that after allo-HSCT the CMV infection occurs frequently. The patients with GVHD have a higher incidence of CMV infection. Ganciclovir and foscarnet sodium are reliable to be used for treatment of CMV infection with fewer adverse reactions.

Opioid receptor trafficking and signaling: what happens after opioid receptor activation?

Prolonged opioid treatment leads to a comprehensive cellular adaptation mediated by opioid receptors, a basis to understand the development of opioid tolerance and dependence. However, the molecular mechanisms underlying opioid-induced cellular adaptation remain obscure. Recent advances in opioid receptor trafficking and signaling in cells have extensively increased our insight into the network of intracellular signal integration. This review focuses on those important intracellular biochemical processes that play critical roles in the development of opioid tolerance and dependence after opioid receptor activation, and tries to explain what happens after opioid receptor activation, and how the cellular adaptation develops from cell membrane to nucleus. Decades of research have delineated a network on opioid receptor trafficking and signaling, but the challenge remains to explain opioid tolerance and dependence from a single cellular signal network.