Expert consensus on prevention and cardiopulmonary resuscitation for cardiac arrest in COVID-19

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Subcutaneous phaeohyphomycosis caused by Hongkongmyces snookiorum in a kidney transplant patient: a case report.

BACKGROUND: Morbidity and mortality in transplant patients is increased by infection caused mainly by rare opportunistic pathogens. The present study reports a case where Hongkongmyces snookiorum caused subcutaneous phaeohyphomycosis in a kidney transplant patient. CASE PRESENTATION: A 47-year old Chinese woman with chronic kidney disease 5 underwent kidney transplantation 3 years ago. Her regular medications included Tacrolimus (1 mg, two times daily), Mycophenolate Mofetil (two times 250 mg, twice daily) and Prednisone acetate tablets (5 mg daily). Eighteen months ago, her proximal right index finger was red, painful and swollen. After admission, a hard and fluctuating 1 cm × 1 cm abscess was found on the dorsal side of the right index finger. Gram and fluorescence staining of a direct smear of a syringe extraction from the abscess revealed presence of filamentous fungi. White velvet colonies (2-3 mm) were found on blood plate and Sabouraud glucose agar (SGA) after 1 week, and grey aerial hyphae were observed. After 15 days, a 26 mm gray colony was also observed on SGA. The homology between this filamentous fungus and Hongkongmyces snookiorum ILLS00125755 (Genbank Sequence ID: MH161189.1) was 99.66%. An in vitro antifungal susceptibility test showed that this filamentous fungus was sensitive to azoles such as itraconazole and voriconazole. CONCLUSIONS: We report an opportunistic fungus infection caused by Hongkongmyces snookiorum in a transplant patient. Our finding shows that prevention of subcutaneous fungal infection is necessary for kidney transplantation patients.

Glucocorticoid inhibit immature rat's bone growth and development of experimental research / 中国医师杂志

Objective To explore bone formation markers in dexamethasone intervention osteocalcin (OC),bone alkaline phosphatase (BAKP),and type Ⅰ original amino terminal propcptide (PINP) relationship with bone longitudinal growth.Methods The selected thirty-three 4-week-old male SpragueDawley (SD) rats were randomly divided into two groups:the dexamethasone group (n =18) and the control group (n =15).The rats in the dexamethasone group received dexamethasone (200 μg/100 g) by intraperitoneal injection for 10 days.The rats in the control group received matching volume sodium chloride solution.All rats were weighed everyday.The rats were killed by using 10％ chloral hydration at 8 AM of 11 th day.The length of tibiae was measured.The proximal tibiae were excised,fixed and decaleified.Mter paraffin embedded,sections in 5 μm thick were cut.The growth plate sections were stained by haematoxylin-eosin (HE) histochemistry method.Total height of growth plate was measured.The rats decaptitating and the blood were collected.Serum was separated and stored in-80 ℃ refrigerator for analysis.Enzyme -linked immuno sorbent assay (ELISA) method was used to detect the rat OC,BAKP and PINP values.Results The length of growth plate and tibiae of dexamethasone group were significantly decreased contrast the control group:the length of growth plate (P =0.001),and the length of tibiae (P =0.000).There were no significant differences between two groups of the value of OC,BAKP and PINP:OC (P =0.056),BAKP (P=0.122),and PINP (P =0.169).There was positive correlation between the serum OC and the length of tibiae (r =0.454,P =0.08) in control group,the PINP and OC (r =0.521,P =0.026) in dexamethasone group.Conclusions Glucocorticoid inhibit the longitudinal bone growth,to the osteoblasts (OC,BAKP and PINP) of growing rats is not obvious.

Histological evaluation of type I collagen scaffolds preparde under different dehydrothermal cross-linking conditions in a rat model / 中国组织工程研究

BACKGROUND:In previous studies, the dehydrothermal cross-linking method was modified by the authors to improve the degradation property of colagen scaffolds. The cross-linking time was increased from 24 to 48 hours, and the cross-linking temperature increased from 105 to 115℃. OBJECTIVE:To verify the anti-degradation ability of colagen scaffolds prepared using the modified dehydrothermal cross-linking method and to obtain the optimal efficacy of the scaffolds on damaged tissue repair and regeneration. METHODS: Highly-purified type I colagen scaffolds with native triple helix structure were prepared and subjected to three different dehydrothermal cross-linking conditions: 105℃ for 24 hours, 105℃ for 48 hours and 115℃ for 24 hours. Material samples, 1 cm×1 cm, were implanted subcutaneously into the rat dorsum. The specimens were harvested at 3 days, 14 days and 42 postoperative days folowed by fixation and histological analysis using hematoxylin-eosin staining. RESULTS AND CONCLUSION:No untoward foreign body and immunological reactions were observed in any groups. In the group of 105℃ for 48 hours, the scaffold retention and degree of pore openness were better than the other two groups at 14 days after scaffold implantation (P < 0.05). These findings indirectly suggest that the anti-degradation ability of colagen scaffolds can be strengthened under certain dehydrothermal cross-linking conditions: the cross-linking time is increased from 24 to 48 hours.

Evaluation of the capabilities of disc diffusion and Vitek2-compact GN13 methods for testing antimi-crobial susceptibility and screening of ESBLs Enterobacteriaceae clinical isolates / 中华微生物学和免疫学杂志

Objective To evaluate the capabilities of disc diffusion and Vitek2-compact GN13 methods for testing antimicrobial susceptibility of screening ESBLs ( extended-spectrumβ-lactamase) in En-terobacteriaceae clinical isolates.Methods A total of 93 Enterobacteriaceae strains were isolated from pa-tients with intra-abdominal infections in 21 hospitals during 2011 to 2012.The in vitro minimum inhibition concentration ( MIC ) values of ampicillin-sulbactam, piperacillin-tazobactam, ertapenem, ceftazidime, ceftriaxone, cefepime, imipenem, amikacin, ciprofloxacin and levofloxacin were determined by disc diffu-sion, Vitek2-compact GN13 and broth microdilution methods, respectively.Categorical agreement ( CA ) rates of disc diffusion and Vitek2-compact GN13 methods were determined by using broth microdilution meth-od as the reference method.The genes encoding ESBLs were screened in Escherichia coli (E.coli), Kleb-siella pneumoniae (K.pneumonia), Klebsiella oxytoca (K.oxytoca) and Proteus mirabilis (P.mirabilis) strains by using PCR analysis and gene sequencing.Disc diffusion and Vitek2-compact GN13 methods were used for the phenotypic confirmatory test of ESBLs and the sensitivity, specificity, positive predictive value and negative predictive value of the two tests were evaluated.Results The CA values of disc diffusion and Vitek2-compact GN13 methods for the 10 antibiotics were all >90% as compared with broth microdilution method.The major error (ME) rate for ertapenem was 3.2%and the very major error (VME) rates for am- picillin-sulbactam, ceftazidime and cefepime tests were all 2.2% by using Vitek2-compact GN13 method. The sensitivity, specificity, positive predictive value and negative predictive value of disc diffusion and Vitek2-compact GN13 methods in the phenotypic confirmatory test of ESBLs were 96.7%(29/30), 100%(20/20), 100%(30/30) and 95%(19/20), respectively.Conclusion Both disc diffusion and Vitek2-compact GN13 methods could be used for testing the antimicrobial susceptibility and the detection of ESBLs in Enterobacteriaceae clinical isolates with the advantage of accuarcy.Attention should be paid to the posibil-lity of oaurance of ME and VME when testing ertapenem, ampicillin-sulbactam, ceftazidime and cefepime by using Vitek2-compact GN13 method.

Staphylococcal chromosome mec genotyping and molecular epidemiology of hospi-tal-acquired methicillin-resistant Staphylococcus aureus / 中国感染与化疗杂志

Objective To investigate the staphylococcal chromosomal cassette mec (SCCmec)genotypes and molecular epidemi-ology of hospital-acquired MRSA.Methods A total of 26 non-duplicate MRSA isolates with the same resistant pattern were studied.SCCmec genotyping was analyzed by multiplex PCR.Repetitive element polymerase chain reaction (Rep-PCR)tech-nique was used to analyze the homology between these strains based on the DiversiLab system.Results The most common geno-type of these MRSA strains was SCCmec-III (84.6%).Two strains belonged to SCCmec-II and 1 SCCmec-IV.SCCmec-I strain was not identified.Based on the results of DiversiLab analysis,these MRSA strains were classified into 10 groups.The genetic similarity ranged from 40% to 100% among these SCCmec types.The two strains of SCCmec-II belonged to the same subtype.The similarity coefficient was higher than 90% for one strain of SCCmec-III subtype 1.The 4 strains of SCCmec-III subtype 3 were grouped into the same set with a similarity coefficient of > 95%.The MRSA strains of SCCmec-III subtype 2 was divided into 5 groups (similarity co-efficient > 90%).Conclusions SCCmec-III is the major genotype of MRSA isolates in our hospital.MRSA strains may spread in some wards.Clinicians and infection control department should pay close attention to this issue.

Development trend of modern hospital outpatient management system / 医疗卫生装备

In modern hospital outpatient management, patients should be paid more attention to than hospital management and economic management. Automatic and paperless management is also important. So, the software and hardware all should be updated to gain great social and economic benefit.