To identify the patterns of antibiotic use and irrational antibiotic prescriptions in primary healthcare institutions (PHIs) in Dongcheng District of Beijing, China.
All primary healthcare ...institutions (7 community healthcare centres and 59 community healthcare stations in total) in Dongcheng District were included in the study. Prescription data from January 2015 to December 2018 was derived from the Beijing Prescription Reviewing System of Primary healthcare institutions and analysed retrospectively. The antibiotic prescription rate was calculated and cases of irrational antibiotic prescriptions were identified.
We extracted 11,166,905 prescriptions from the database. Only 189,962 prescriptions were included in the study, among which 9167 (4.8%) contained antibiotics. The antibiotic prescription rate fell from 5.2% in 2015 to 4.1% in 2018 while irrational antibiotic prescription rate increased from 10.4 to 11.8%. Acute Bronchitis was the most prevalent diagnosis (17.6%) for antibiotic prescriptions, followed by Unspecified Acute Respiratory Tract Infection (14.4%), Acute Tonsillitis (9.9%), and Urinary Tract Infection (6.4%). Around 10% of the prescriptions for the top 7 diagnoses identified were rated as irrational. Cephalosporins, fluoroquinolones, and macrolides were the most prescribed antibiotics, which accounted for 89.3% of all antibiotic prescriptions. Of all the antibiotic prescriptions, 7531 were reviewed, among which 939 (12.5%) were rated as irrational because of antibiotic use. Among all the irrational prescriptions, prescriptions with inappropriate antibiotic use and dosage accounted for the majority (54.4%).
Although a relatively low level of antibiotic utilization was found in PHIs in Dongcheng District of Beijing, the utilization patterns differed considerably from developed countries and irrational prescriptions remained. Considering the imbalanced allocation of medical resources between primary healthcare setting and secondary and tertiary hospitals, there need to be more efforts invested in regions with different levels of economic development.
Objectif Analyser les tendances et schemas propres a l'utilisation des antibactériens en milieu hospitalier dans les hôpitaux secondaires et tertiaires en Chine, entre 2013 et 2021. Méthodes ...L'analyse repose sur des données trimestrielles provenant d'hôpitaux couverts par le Center for Antibacterial Surveillance chinois. Nous nous sommes procuré des informations sur les caractéristiques des hôpitaux (province, code hospitalier anonymise, niveau de l'établissement et jours d'hospitalisation par exemple) et des antibactériens (notamment le nom générique, la classe pharmacologique, le dosage, le mode d'administration et le volume utilisé). Nous avons quantifié l'usage d'antibactériens et le nombre de doses journalieres définies par 100 jours-patients. Lanalyse a pris en compte la classification AWaRe (Access, Watch et Reserve) de (Organisation mondiale de la Santé. Résultats Entre 2013 et 2021, le recours global aux antibactériens en milieu hospitalier a considérablement diminué, passant de 48,8 a 38,0 doses journalieres définies pour 100 jours-patients (P < 0,001). En 2021, les variations entre provinces étaient presque multipliées par deux: 29,1 doses journalieres définies pour 100 jours-patients dans le Qinghai, contre 55,3 au Tibet. Pendant toute la durée de l'étude, les antibactériens d'usage le plus courant, tant dans les hôpitaux secondaires que tertiaires, étaient les céphalosporines de troisieme génération, qui représentaient pres d'un tiers de l'usage total d'antibactériens. Les carbapénemes ont été ajoutés a la liste des classes d'antibactériens les plus utilisées en 2015. D'apres la classification de l'OMS, les antibactériens les plus fréquemment employés appartenaient a la catégorie Watch: leur usage a sensiblement augmenté, passant de 61,3% (29,9/48,8) en 2013 a 64,1% (24,4/38,0) en 2021 (P < 0,001). Conclusion Lemploi d'antibactériens en milieu hospitalier a connu une forte baisse au cours de la période d'étude. Cependant, le pourcentage d'utilisation croissant des antibactériens de dernier recours est inquiétant, tout comme l'important décalage entre le pourcentage d'antibactériens utilisés appartenant a la catégorie Access et la cible mondiale de l'OMS, qui consiste a ne pas dépasser les 60%.
The harmful effects of mycotoxins on intestinal health have received worldwide attention. Mycotoxins are toxic secondary metabolites produced by filamentous fungi, and include aflatoxins, ...ochratoxins, patulin, fumonisins, zearalenone, trichothecenes, and ergot alkaloids. Insuring the absence or low levels of mycotoxins is critical for food and feed safety. Currently, the studies in this field have illuminated the adverse effects of mycotoxins on gut health including intestinal integrity and the gut-associated immune system. By affecting the proteins and peptides that serve vital functions in the immune system and host metabolism, mycotoxins are able to attack intestinal epithelium, which leads to poor intestinal health and integrity. This review focuses on the effects of exposure to mycotoxins on the intestinal barrier, especially the gut microbiome, intestinal local immune system, and tight junction proteins, which in return influence digestion, absorption, metabolism and transport of the nutrients in intestinal lumen. The crucial role of mycotoxins on microbial metabolism and antimicrobial properties is also assessed, which elucidates the relationship between exposure to mycotoxins and the intestinal microbiome. We hypothesize that the key small peptides and proteins regulate the causal relationship between mycotoxins and gut microbiome.
Abstract
Background
Metastasis is still a major cause of poor pathological outcome and prognosis in esophageal squamous cell carcinoma (ESCC) patients. NUAK1 has been reported highly expressed in ...many human cancers and is associated with the poor prognosis of cancer patients. However, the role of NUAK1 and its underlying signaling mechanism in ESCC metastasis remain unclear.
Methods
Expression of NUAK1 in ESCC was detected by real-time quantitative RT-PCR (qRT-PCR), Western blotting and immunohistochemical staining. MTT, colony formation, wound-healing and transwell assays were used to determine the role NUAK1 in vitro. Metastasis was evaluated by use of an experimental pulmonary metastasis model in BALB/c-nu/nu mice. The mechanisms were assessed by using coimmunoprecipitation, immunofluorescence and dual-luciferase reporter gene experiments.
Results
NUAK1 was highly expressed in ESCC tissues compared with the adjacent normal esophageal epithelial tissues. Moreover, the elevated expression of NUAK1 positively correlated with tumor invasion depth, lymph node metastasis, pathological TNM stage, and poor survival in ESCC patients. Further experiments showed that NUAK1 overexpression did not change the cell viability and colony formation of ESCC cells, while remarkably promoted the migration and invasion in vitro and experimental pulmonary metastasis in vivo. Mechanistically, NUAK1 enhanced the transcription level of Slug, which enhanced the migratory and invasive capability of ESCC cells. Consistently, silencing Slug almost completely diminished the migration and invasion of NUAK1-overexpressing ESCC cells. Further studies demonstrated that NUAK1 upregulated the transcription activity of Slug through activating the JNK/c-Jun pathway.
Conclusion
These results demonstrated that NUAK1 promoted the metastasis of ESCC cells through activating JNK/c-Jun/Slug signaling, indicating NUAK1 is a promising therapeutic target for metastatic ESCC.
CO2-responsive foaming has been drawing huge attention due to its unique switching characteristics in academic research and industrial practices, whereas its stability remains questionable for ...further applications. In this paper, a new CO2-switchable foam was synthesized by adding the preferably selected hydrophilic nanoparticle N20 into the foaming agent C12A, through a series of analytical experiments. Overall, the synergy between cationic surfactants and nanoparticles with a contact angle of 37.83° is the best. More specifically, after adding 1.5 wt% N20, the half-life of foam is 14 times longer than that of pure C12A foam. What’s more, the C12A-N20 solution is validated to own distinctive CO2-N2 switching features because very slight foaming degradations are observed in terms of the foaming volume and half-life time even after three cycles of CO2-N2 injections. This study is of paramount importance pertaining to future CO2 foam research and applications in energy and environmental practices.
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•Cationic surfactants have the best synergy with NPs with a contact angle of 37.83°•The foam stability increased with the increase of NPs concentration•CO2/N2 can control the foaming properties of C12A-N20 solution and are reversible
Chemistry; Materials science; Materials chemistry; Materials synthesis
(1) Background: Few studies have focused on antibiotic use and appropriateness in children in primary health institutions (PHIs). This study aimed to identify the patterns and appropriateness of ...antibiotic use for children in PHIs in Beijing, China. (2) Methods: Outpatient prescriptions of 327 PHIs from 2017 to 2019 for patients <18 years old were collected. Prescriptions were described using quantity indicators. Antibiotics were categorized according to ATC classification J01 and Access, Watch, Reserve grouping. Appropriateness was reviewed by experts using three subtypes of irrational prescriptions (irregular, inappropriate, and abnormal). (3) Results: 20,618 prescriptions were collected in total. The antibiotic prescription rate (APR) was 15.1% (
= 3113). Among antibiotic prescriptions, J01FA Macrolides were the most used (
= 1068, 34.9%). The Watch group constituted 89.0% (
= 2818) of total antibiotic use. Bronchitis (
= 1059, 35.2%) was the most common diagnosis. A total of 292 instances of irrational antibiotic use were identified, with inappropriate prescriptions being the most prevalent subtype (
= 233, 79.8%). (4) Conclusion: Although APR for children in PHIs in Beijing was relatively low, the pattern of antibiotic use differed from other countries. Further studies are needed to optimize antibiotic use for children in PHIs under different levels of economic development.
Antimicrobial resistance, exacerbated by antibiotic misuse, poses a global threat. Though delayed antibiotic prescribing (DAP) can mitigate antibiotic overuse, its adoption in developing nations, ...such as China, is limited. This study probed barriers and facilitators to DAP in Xinjiang, characterized by extensive rural landscapes and primary care institutions (PCIs).
Adopting a qualitative methodology, we conducted key informant interviews with thirty participants across six county hospitals in Xinjiang using VooV Meeting. Employing a two-stage sampling method targeting economically diverse areas, our interviews spanned physicians, pharmacists, patients, and caregivers. We organized the data according to the Theoretical Domains Framework (TDF) and the Behavior Change Wheel (BCW), spotlighting behavioral and policy elements impacting DAP.
Our research included thirty interviewees. Twelve physicians contemplated delayed prescriptions, while five adult patients and six caregivers encountered recommendations for delayed antibiotic prescriptions. Six patients sought pharmacists' advice on antibiotic necessity. Prominent TDF domains were memory, attention, and beliefs about consequences. Critical intervention functions included education and environmental restructuring, while vital policy categories encompassed communication/marketing and guidelines.
Countering antibiotic misuse and resistance in China necessitates overcoming barriers through strategic resource distribution, comprehensive education, rigorous training, and consistent monitoring, thereby promoting DAP adoption. The adoption of DAP in rural healthcare settings in China has the potential to significantly reduce antibiotic misuse, thereby mitigating the global threat of antimicrobial resistance.
There is scarce evidence to demonstrate the pattern of antibiotic use in children in China. We aimed to describe antibiotic prescribing practices among children in primary healthcare institutions ...(PHIs) in China. We described outpatient antibiotic prescriptions for children in PHIs from January 2017 to December 2019 at both the national and diagnostic levels, utilizing the antibiotic prescribing rate (APR), multi-antibiotic prescribing rate (MAPR), and broad-spectrum prescribing rate (BAPR). Generalized estimating equations were adopted to analyze the factors associated with antibiotic use. Among the total 155,262.2 weighted prescriptions for children, the APR, MAPR, and BAPR were 43.5%, 9.9%, and 84.8%. At the national level, J01DC second-generation cephalosporins were the most prescribed antibiotic category (21.0%, N = 15,313.0), followed by J01DD third-generation cephalosporins (17.4%, N = 12,695.8). Watch group antibiotics accounted for 55.0% of the total antibiotic prescriptions (N = 52,056.3). At the diagnostic level, respiratory tract infections accounted for 67.4% of antibiotic prescriptions, among which prescriptions with diagnoses classified as potentially bacterial RTIs occupied the highest APR (55.0%). For each diagnostic category, the MAPR and BAPR varied. Age, region, and diagnostic categories were associated with antibiotic use. Concerns were raised regarding the appropriateness of antibiotic use, especially for broad-spectrum antibiotics.
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