Establishment of extensively drug-resistant Pseudomonas aeruginosa pneumonia model in rat

Objective:To establish extensively drug-resistant Pseudomonas aeruginosa(XDR-PA)infection-induced pneumonia model in rats.Methods:Twenty-four male SD rats were randomly divided into blank group,low bacterial group,medium bacterial group,and high bacterial group.The low,medium and high bacterial groups were given intratracheal instillation of 0.1 mL of bacterial suspension(bacterial concentration in turn is 7.5×10^(9),3×10^(10),6×10^(10)CFU/mL),while the blank group were given the same volume of sterile normal saline.After modeling,the general conditions of rats in each group were observed,including mental state,hair,respiration,activity,eating,weight,and the survival curve was drawn.The pathological characteristics of lung tissue and the infiltration of inflammatory cells were observed.Pathogenic identification of each group was carried out by bacterial culture of lung tissue homogenate.Results:The general state of the blank group was normal,and the rats in other groups showed signs of mental depression,bristling,shortness of breath,even oral and nasal bleeding,decreased food intake and activity,and significant weight loss,and different degrees of death within 48 hours,the difference was statistically significant(P<0.05).Pathological results showed that the alveolar structure of rats in the blank group was complete,and the alveolar space was clear without exudation.The lung tissue of the low and medium bacterial groups showed obvious inflammatory cell infiltration,alveolar structure destruction,alveolar septum thickening,interstitial edema,but the pathological damage of the medium group was more severe,with a mortality rate of up to 50%,and the mortality rate of the low bacterial group was 17%.In the high bacterial group,red blood cells,inflammatory cells and a large amount of fibrin-like exudation can be seen in the alveolar space,which has the pathological characteristics of acute respiratory failure,and the mortality rate is as high as 67%.The results of bacterial culture of lung tissue homogenate showed that the blank group had no bacterial colonies,while PA colony growth can be seen in low,medium and high bacterial groups.Conclusion:9 Intratracheal instillation of low bacterial count(0.1 mL of 7.5×10^(9) CFU/mL)XDR-PA bacterial suspension can successfully construct a rat pneumonia model of XDR-PA infection.

Extensively drug-resistant bacteria are an independent predictive factor of mortality in 130 patients with spontaneous bacterial peritonitis or spontaneous bacteremia

AIM: To evaluate the epidemiology and outcomes of culture-positive spontaneous bacterial peritonitis (SBP) and spontaneous bacteremia (SB) in decompensated cirrhosis.METHODS: We prospectively collected clinical, laboratory characteristics, type of administered antibiotic, susceptibility and resistance of bacteria to antibiotics in one hundred thirty cases (68.5% males) with positive ascitic fluid and/or blood cultures during the period from January 1, 2012 to May 30, 2014. All patients with SBP had polymorphonuclear cell count in ascitic fluid > 250/mm3. In patients with SB a thorough study did not reveal any other cause of bacteremia. The patients were followed-up for a 30-d period following diagnosis of the infection. The final outcome of the patients was recorded in the end of follow-up and comparison among 3 groups of patients according to the pattern of drug resistance was performed.RESULTS: Gram-positive-cocci (GPC) were found in half of the cases. The most prevalent organisms in a descending order were Escherichia coli (33), Enterococcus spp (30), Streptococcus spp (25), Klebsiella pneumonia (16), S. aureus (8), Pseudomanas aeruginosa (5), other Gram-negative-bacteria (GNB) (11) and anaerobes (2). Overall, 20.8% of isolates were multidrug-resistant (MDR) and 10% extensively drug-resistant (XDR). Health-care-associated (HCA) and/or nosocomial infections were present in 100% of MDR/XDR and in 65.5% of non-DR cases. Meropenem was the empirically prescribed antibiotic in HCA/nosocomial infections showing a drug-resistance rate of 30.7% while third generation cephalosporins of 43.8%. Meropenem was ineffective on both XDR bacteria and Enterococcus faecium (E. faecium). All but one XDR were susceptible to colistin while all GPC (including E. faecium) and the 86% of GNB to tigecycline. Overall 30-d mortality was 37.7% (69.2% for XDR and 34.2% for the rest of the patients) (log rank, P = 0.015). In multivariate analysis, factors adversely affecting outcome included XDR infection (HR = 2.263, 95%CI: 1.005-5.095, P = 0.049), creatinine (HR = 1.125, 95%CI: 1.024-1.236, P = 0.015) and INR (HR =1.553, 95%CI: 1.106-2.180, P = 0.011).CONCLUSION: XDR bacteria are an independent life-threatening factor in SBP/SB. Strategies aiming at restricting antibiotic overuse and rapid identification of the responsible bacteria could help improve survival.

Prolonged use of bedaquiline in two patients with pulmonary extensively drug-resistant tuberculosis: Two case reports

BACKGROUND Bedaquiline is among the prioritized drugs recommended by the World Health Organization for the treatment of extensively drug-resistant tuberculosis(XDRTB).Many patients have not achieved better clinical improvement after bedaquiline is stopped at 24 wk.However,there is no recommendation or guideline on bedaquiline administration beyond 24 wk,which is an important consideration when balancing the benefit of prognosis for XDR-TB against the uncertain safety concerning the newer antibiotics.CASE SUMMARY This paper reported 2 patients with XDR-TB(a female of 58 years of age and a female of 18 years of age)who received bedaquiline for 36 wk,as local experience to be shared.The 2 cases had negative cultures after 24 wk of treatment,but lung imaging was still positive.After discussion among experts,the consensus was made to bedaquiline prolongation by another 12 wk.The 36-wk prolonged use of bedaquiline in both cases achieved a favorable response without increasing the risk of cardiac events or new safety signals.CONCLUSION Longer regimen,including 36-wk bedaquiline treatment,might be an option for patients with XDR-TB.More studies are needed to explore the effectiveness and safety of prolonged use of bedaquiline for 36 wk vs standard 24 wk in the treatment of multidrug-resistant/XDR-TB or to investigate further the biomarkers and criteria indicative for extension of bedaquline to facilitate clinical use of thisnovel drug.

Successful treatment of pyogenic ventriculitis caused by extensively drug-resistant Acinetobacter baumannii with multi-route tigecycline: A case report

BACKGROUND Pyogenic ventriculitis caused by extensively drug-resistant Acinetobacter baumannii(A.baumannii)is one of the most severe complications associated with craniotomy.However,limited therapeutic options exist for the treatment of A.baumannii ventriculitis due to the poor penetration rate of most antibiotics through the blood-brain barrier.CASE SUMMARY A 68-year-old male patient with severe traumatic brain injury developed pyogenic ventriculitis on postoperative day 24 caused by extensively drug-resistant A.baumannii susceptible to tigecycline only.Successful treatment was accomplished through multi-route administration of tigecycline,including intravenous combined with continuous ventricular irrigation plus intraventricular administration.The pus was cleared on the 3rd day post-irrigation,and cerebrospinal fluid cultures were negative after 12 d.CONCLUSION Our findings suggest that multi-route administration of tigecycline can be a therapeutic option against pyogenic ventriculitis caused by extensively drugresistant A.baumannii.

Global burden of HIV-negative multidrug-and extensively drug-resistant tuberculosis based on Global Burden of Disease Study 2021

Background Tuberculosis(TB),caused by Mycobacterium tuberculosis,remains the second leading cause of death from a single infectious disease globally and poses a significant economic and clinical burden in the world in 2022.Of particular concern is the emergence of drug-resistant TB,accounting for 15%-20%of TB deaths.It is imperative to delve into the global trends of incidence and death rate for multidrug-resistant tuberculosis(MDR-TB)and extensively drug-resistant tuberculosis(XDR-TB),drawing upon the comprehensive Global Burden of Disease(GBD)2021 drug-resistant tuberculosis dataset.Methods From the GBD 2021,data on incidence,prevalence,disability-adjusted life years(DALYs),and death of MDR-TB and XDR-TB from 1990 to 2021 were collected.We calculated the estimated annual percentage changes in age standardized incidence rate(ASIR)and age-standardized death rate(ASDR),segmented by age,sex,and socio-demographic index(SDI).The impacts of various risk factors on MDR-TB and XDR-TB were also analyzed.Results In 2021,there were an estimated 443,680(95%uncertainty interval[UI]:259,196-766,545)incident cases of MDR-TB,and an estimated 106,818(95%UI:41,612-211,854)death cases of MDR-TB,while there were an estimated 24,036(95%UI:17,144-34,587)incident cases of XDR-TB and 7,946(95%UI:3,326-14,859)death cases of XDR-TB.The incidence and death cases of MDR-TB were lowest in high SDI regions,whereas the incidence rates of XDR-TB in high-middle SDI regions were higher than those in middle SDI and high SDI regions.Conclusion This study reported the disease burden of drug-resistant TB from 1990 to 2021.Until 2021,drug-resistant TB is still a serious problem in low SDI countries,especially for high-risk age populations with high-risk factors.Controlling drug-resistant TB requires effective control strategies and healthcare systems.

嵌入视角下小农户与现代农业的有机衔接——以河北省G村内生型服务组织的农技推广过程为例

聚焦河北省邢台市G村内生型服务组织的农技推广过程,运用嵌入理论从制度嵌入、关系嵌入、文化嵌入三个维度探讨该组织在技术、服务、市场等方面带动小农户融入现代市场的动力机制。发现村庄通过采用先进的苹果种植技术,完成了农户家庭经营的精细化、集约化、高附加值化和村庄生产的农业组织化、规模化、产品标准化、地方特色化,进而实现了小农户与现代农业发展的有机衔接。在制度嵌入方面,服务组织依托村委会的制度资源、村规民约、乡村政治精英示范等完成了“行政化”组织动员机制;在关系嵌入方面,服务组织基于熟人社会的人情、信任、互利共生等实行了互惠交换机制;在文化嵌入方面,服务组织凭借共享的价值观念、品牌文化建设和富有意义的实践等实现了村庄整合机制。“村社组织+内生型服务组织+技术专家+农户”的发展模式,构建了小农户主体性的利益共同体,推动了村庄从传统维持型向现代发展型村落的转变。

Clinical analysis of colistin sulfate in the treatment of pneumonia caused by carbapenem-resistant Gram-negative bacteria

BACKGROUND Multidrug-resistant Gram-negative bacteria,exacerbated by excessive use of antimicrobials and immunosuppressants,are a major health threat.AIM To study the clinical efficacy and safety of colistin sulfate in the treatment of carbapenem-resistant Gram-negative bacilli-induced pneumonia,and to provide theoretical reference for clinical diagnosis and treatment.METHODS This retrospective analysis involved 54 patients with Gram-negative bacilli pneumonia admitted to intensive care unit of The General Hospital of the Northern Theater Command of the People's Liberation Army of China from August 2020 to June 2022.After bacteriological culture,the patients'airway secretions were collected to confirm the presence of Gram-negative bacilli.The patients were divided into the experimental and control groups according to the medication used.The research group consisted of 28 patients who received polymyxin sulfate combined with other drugs through intravenous,nebulization,or intravenous combined with nebulization,with a daily dosage of 1.5–3.0 million units.The control group consisted of 26 patients who received standard dosages of other antibiotics(including sulbactam sodium for injection,cefoperazone sodium sulbactam for injection,tigecycline,meropenem,or vaborbactam).RESULTS Of the 28 patients included in the research group,26 patients showed improvement,treatment was ineffective for two patients,and one patient died,with the treatment efficacy rate of 92.82%.Of the 26 patients in the control group,18 patients improved,treatment was ineffective for eight patients,and two patients died,with the treatment efficacy rate of 54.9%;significant difference was observed between the two groups(P<0.05).The levels of white blood cell(WBC),procalcitonin(PCT),and C-reactive protein(CRP)in both groups were significantly lower after treatment than before treatment(P<0.05),and the levels of WBC,PCT,and CRP in the research group were significantly lower than those in the control group(P<0.05).Compared with before treatment,there were no significant changes in aspartate aminotransferase,creatinine,and glomerular filtration rate in both groups,while total bilirubin and alanine aminotransferase decreased after treatment(P<0.05)with no difference between the groups.In patients with good clinical outcomes,the sequential organ failure assessment(SOFA)score was low when treated with inhaled polymyxin sulfate,and specific antibiotic treatment did not improve the outcome.Sepsis and septic shock as well as a low SOFA score were independent factors associated with good clinical outcomes.CONCLUSION Polymyxin sulfate has a significant effect on the treatment of patients with multiple drug-resistant Gram-negative bacilli pneumonia and other infections in the lungs and is safe and reliable.Moreover,the administration route of low-dose intravenous injection combined with nebulization shows better therapeutic effects and lower adverse reactions,providing new ideas for clinical administration.

“海之星”有机营养型氨基酸水溶肥对郁金香观赏期延长的研究

郁金香(Tulipa L.)花色丰富,耐低温,常用于早春的花境及花海打造,当前主要通过改善土壤及温度条件来调控花期。针对郁金香开花所需要的有效积温、有效光照、最佳激素配比及其与其他影响因子的交互效应,尤其是对影响郁金香花芽分化及花器官发育的基础研究很少。基于此,通过试验规律地喷施1000倍“海之星”有机营养型氨基酸水溶肥能够有效延长郁金香的观赏期7~9 d,同时能不同程度地提前郁金香观赏期,提升郁金香花期观赏状态,为提前和延长其他花卉观赏期提供参考。

城市高快速路改扩建工程施工期间交通组织研究

以城市高快速路改扩建工程施工期间的交通组织为研究对象,通过深入探讨基本原则和具体措施,揭示施工期间优化交通组织的关键要点,为城市高快速路改扩建工程提供科学、高效的交通管理方案,促进城市高快速路改扩建工程的顺利实施。研究成果可为类似工程提供有益的经验借鉴,旨在促进施工期间城市交通组织的科学管理和进一步的优化。

高速公路改扩建方式和交通组织发展研究总结

随着早期建设的高速公路使用寿命逐步萎缩以及近些年车辆数激增带来的巨大交通压力,我国已进入高速公路改扩建的快速发展阶段。为能够全面和深入了解我国高速公路改扩建的发展规律和特征,整理统计和分析了新近我国实施的117个高速公路改扩建项目,里程规模超10000 km。首先,从高速公路改扩建规模、时间、方式、车道数量等方面总结我国高速公路改扩建方式的发展特征;其次,分析了改扩方式对改扩建期间施工交通组织方式的影响,对改扩建期间的保通方向、保通车道数、保通车型及保通速度进行整理分析,总结我国高速公路改扩建施工交通组织方式的发展规律和特点。

邯长增建二线引入长治地区方案研究

邯长线悬钟至长治北段作为全线唯一单线区段,是通道能力的短板,项目的建设能够提升线路能力、优化区域路网格局、提升路网韧性和灵活性,是补强了路网短板,打通能力瓶颈的重要提升工程。根据地区分方向客货运量、客货运流向、机车交路及长治北站布局、既有车站平面布置条件,统筹考虑太焦二线引入,考虑到研究年度长治北站各方向货物列车仍需在车站换挂机车,同时交接场作为货物的煤炭运量的主要来源,畅通其直接接发车通路,有利于优化运输组织,缓解车站到发场能力,经研究分析,推荐采用增二线并行既有邯长线引入长治北站方案。

岩滩水电站扩建工程尾水检修闸门室施工组织设计优化

针对岩滩水电站扩建工程5号、6号机组尾水检修闸门室施工因尾水隧洞交面时间滞后,闸门室超高超深、空间窄小、地质条件较差而增加施工内容和施工难度等问题,笔者从闸门室开挖支护、混凝土施工、闸门安装等方面阐述了施工组织设计优化,通过改变闸室开挖方案和混凝土施工方式,精心策划,科学安排,实现了优质、高效施工,且按合同工期完工。

Transmission of extensively drug-resistant and multidrug resistant Mycobacterium tuberculosis in families identified by genotyping

Background Diagnosis and appropriate treatment of multidrug-resistant tuberculosis （MDR-TB） remain major challenges. We sought to elucidate that persons who share a household with drug resistance tuberculosis patients are at high risk for primary drug resistance tuberculosis and how to prevent these outbreaks. Methods We used 12-locus mycobactedal interspersed repetitive unit and 7-locus variable-number tandem repeat to identify household transmission of extensively drug resistant and multiple drug resistant Mycobacterium tuberculosis in three families admitted in Shanghai Pulmonary Hospital affiliated with Tongji University. Drug susceptibility tests were done by the modified proportion method in the MGIT 960 system in the same time. Clinical data were also obtained from the subjects＇ medical records. Results All of the six strains were defined as Beijing genotype by the deletion-targeted multiplex PCR （DTM-PCR） identification on the genomic deletion RD105. Strains from family-1 had the same minisatellite interspersed repetitive unit （MIRU） pattern （232225172531） and the same MIRU pattern （3677235）. Strains from family-2 had the same MIRU pattern （2212261553323） and the same MIRU pattern （3685134）. Strains from family-3 did not have the same MIRU pattern and they differed at only one locus （223326173533, 223325173533）, and did not have the same VNTR pattern with two locus differed （3667233, 3677234）. Conclusions Household transmission exists in the three families. A clear chain of tuberculosis transmission within family exists. Tuberculosis susceptibility should be considered when there is more than one tuberculosis patients in a familv. Household tuberculosis transmission could be prevented with adequate treatment of source Patients.

Molecular Detection of Carbapenemase Genes in Extensive Drug Resistant Acinetobacter baumannii Clinical Isolates from ICU Patients, Khartoum

Background: The emergence of carbapenemase producing Acinetobacter baumannii is increasingly reported nowadays and constitutes a major problem to the intensive care unit (ICU) patients with notable extensive-drug resistance ability. The study investigates carbapenemase producing A. baumannii strains exhibiting an extensively drug-resistant (XDR) phenotype, isolated from ICU patients in Khartoum. Methods: A total of 100 nonduplicate Gram-negative coccobacilli strains were obtained from microbiology laboratory of ICU patients’ clinical isolates. Molecular identification of A. baumannii was performed by targeting 16S rRNA gene using specifically designed primers. Then, XDR strains were determined by susceptibility testing (disc diffusion). For detection of carbapenemase genes Polymerase chain reaction (PCR) was carried out. Result: Of 100 ICU clinical isolates, 38 (38.0%) was confirmed A. baumannii strains, those strains showed 100% carbapenem resistance and 60.5% extensive drug resistance to the antibiotics tested. The frequency of carbapenemase producer was 57.9% (22/38) of carbapenem resistance A. baumannii (CRAB). The most common carbapenemase associated with resistance was blaOXA gene followed by blaNDM and blaGES A. baumannii isolates. The co-occurrence of blaOXA-48-like and blaNDM, blaOXA-23-like and blaOXA-51, and blaNDM-1 and blaOXA-51 was detected in 22.7%, 18.2% strains and 4.5% respectively. A unique characteristic of our findings was the coharbouring of the genes blaNDM-1, blaOXA-23-like, blaOXA-51 and blaOXA-143 in 9.1% strains (2/22), and this was the first report in the Khartoum city, Sudan. Conclusion: We have demonstrated for the first time a high prevalence of XDR-carbapenemase producing A. baumannii clinical isolates from ICU patients in Khartoum. Also an emergent blaOXA-143 was reported as High-Risk Clones. This highlights the routine mentoring of XDR-carbapenemase producing A. baumannii to avoid clone dissemination in our region hospitals.

Influence of Reactive Volatile Organic Compounds on Ozone Production in Houston-Galveston-Brazoria Area

Secondary pollutant ozone (O3) formation in a particular area is often influenced by various factors. Source of emissions is one of the factors. In south east Texas, Houston-Galveston-Brazoria (HGB) is a marginal non-attainment area for ozone (O3). A summer episode of May 28 to July 2, 2006 is simulated using Comprehensive Air Quality Model with extensions (CAMx). During this period O3 concentration in HGB often exceeds the National Ambient Air Quality Standards (NAAQS) 0.075 ppm of average 8 hour O3 concentration. HGB area has numerous point sources. Various studies found that some specific volatile organic compounds are very reactive in atmosphere. The objective of this study is to analyze the influence of volatile organic compounds present in point source emissions on the air quality of HGB area. For this purpose ozone sensitivity for HGB area is analyzed by the ratio of hydrogen peroxides (H2O2) to nitric acid (HNO3). HGB area is found NOx limited but reactive VOCs are found to be influential too. From (1-4 June, 2006) maximum O3 concentration was found on weekend, June 3. VOCs such as Acetaldehyde (ALD2), Formaldehyde (FORM) and Alkane (ETHA) showed good correlation with O3 concentrations on that day. In addition, Peroxyacetyl nitrate (PAN) formation was found correlated to higher ozone production. Criteria pollutant Sulfur dioxide (SO2) was found to influence the ALD2 and ETHA concentrations, and thus indirectly influenced O3 production.

SMA490BW耐候钢不同焊接区域裂纹扩展门槛值研究

对SMA490BW耐候钢MAG熔化焊接头的焊核区和热影响区在不同应力比下的裂纹扩展门槛值进行研究,比较两种焊接区域在不同应力比下的抗裂纹扩展能力,用光学显微镜观察两种焊接区域的显微组织,分析应力比和显微组织对裂纹扩展门槛值的影响。结果表明:在同一应力比下,焊核区的裂纹扩展门槛值和抗裂纹扩展能力高于热影响区;对于同种焊接区域,应力比为-1时的裂纹扩展门槛值和抗裂纹扩展能力比应力比为0时的高;焊核区组织的晶粒比热影响区粗大,导致焊核区的裂纹扩展门槛值大于热影响区。

后申克理论的原则、方法及思考

与传统申克理论相较,后申克理论发展变化主要体现在三方面:一是“域扩展”,将申克理论的分析应用扩展至广阔的后调性音乐之中;二是“态拓展”,为适应后调性音乐之特点,后申克理论对基本结构及延长形态作了相应变化与拓展处理;三是理论综合,将申克理论与其他分析方法综合起来,以混合策略来解析作品。有机统一、层次延展是申克理论与后申克理论的共同原则,一言蔽之,道未变,乃象变也。

有机蔬菜种植模式及生态农业技术推广运用要点研究

我国农业历史文化悠久,蔬菜是我国农业的重要组成部分,其种植方式也一直在不断改进优化。随着经济的高质量发展,人们的生活品质逐渐提升,对食用的蔬菜也有了更高的要求。随着农业的发展和相关种植模式的探索,有机蔬菜种植越来越受到青睐,而生态农业技术成为现代化农业发展的重要航向。以有机蔬菜和生态农业为研究对象,阐述了其在助力乡村振兴战略等方面的作用,并制定了有机蔬菜种植模式科学推广方案,旨在为高品质蔬菜的种植以及建设生态化、现代化、可持续发展的农业种植奠定基石。

The Role of Pyridoxine in the Prevention and Treatment of Neuropathy and Neurotoxicity Associated with Rifampicin-Resistant Tuberculosis Treatment Regimens: A Topic Review

Rifampicin-resistant tuberculosis (RR-TB) is a global public health problem caused by mycobacterium tuberculosis resistant to Rifampicin. Drug-induced peripheral neuropathy and neurotoxicity are well-known adverse effects of treatment regimens that cause significant morbidity. Pyridoxine is often added to treatment regimens for the prevention and/or treatment of these side effects. The basis and effectiveness of this practice are unclear. We conducted a systematic review to evaluate the effectiveness of pyridoxine in preventing and/or treating neuropathy and neurotoxicity associated with RR-TB treatment. We included studies with patients with RR-TB who experienced neuropathy or neurotoxicity attributed to RR-TB regimens and were given pyridoxine. Our findings showed contradicting evidence on the use of pyridoxine for preventing or treating neurotoxicity due to cycloserine in the treatment of RR-TB. Moreover, pyridoxine did not have a protective effect against neuropathy and/or neurotoxicity caused by other RR-TB regimens that do not contain isoniazid. In conclusion, we found that withdrawing or withholding medications such as linezolid, cycloserine, thioamides, fluoroquinolones, and ethambutol, implicated in causing neuropathy or neurotoxicity was more effective than using pyridoxine to stop the progression of symptoms, and in some instances, led to their reversal over time.

复合式高速公路改扩建设计方法研究

梳理了复合式高速公路改扩建设计的一般思路,并依托广州市北环高速沙贝至广清段改扩建工程,根据OD交通量现状特征与预测结果,从车道功能划分、交通组织布局、立交节点优化等方面进行了交通组织设计;根据周边控制因素和工程现状影响情况,结合工程的可行性,对双侧桥、中间桥、北侧桥3个方案的总体扩建方式进行了论证。最终认为,双侧桥设计方案最佳,其预测的末年主线及匝道服务水平均在三级以上,可以妥善解决路段交通拥堵问题,且项目内部收益率高于社会折现率,经济效益较好。