Background We examined the detection and spread of carbapenem-resistant Citrobacter freundii in Huashan Hospital, Shanghai, China between 2005 and 2008. Methods Twenty-three isolates of ...carbapenem-resistant C freundii collected in our hospital underwent resistant gene amplification by polymerase chain reaction, followed by minimal inhibitory concentration (MIC) analysis. Molecular epidemiologic analyses included pulsed-field gel electrophoresis and case study. Results Analysis of MICs with amikacin, gentamicin, cefotaxime, ceftazidime, cefepime, imipenem, meropenem, ertapenem, cefoxitin, piperacillin-tazobactam, and ciprofloxacin characterized the isolates as highly resistant to antimicrobials. Colistin, tigecycline, minocycline, and doxycycline to all C freundii isolates had lower MICs than the other antimicrobials tested, with MIC50 /MIC90 values of 0.5/1, 1/1, 4/8, and 4/4 mg/L, respectively. Molecular typing using pulsed-field gel electrophoresis classified the isolates into 4 groups, of which 15 isolates belonged to a single clone. In total, all of the isolates produced KPC-2-type carbapenemase, of which most were likely to couple with CTX-M-type extended-spectrum β-lactamases and plasmid-mediated CMY-2-type AmpC enzyme. Subsequent clinical investigations involving the general status of patients, the ward, and antimicrobial and therapeutic outcomes showed that a carbapenem-resistant clone had spread critically in the Department of Neurosurgery. Potential risk factors were identified, including invasive procedures, surgical operations, use of indwelling urine catheters, and number of sickbed changes. Conclusion The spread of carbapenem-hydrolyzing C freundii isolates has emerged in regional hospitals in China. Multidrug-resistant mechanisms of strains severely hamper control efforts. Our findings should alert clinicians to issues involved with preventing the spread of carbapenem-resistant C freundii.
The decomposition of macrophytes plays a crucial role in the nutrient cycles of macrophyte-dominated eutrophication lakes. While research on plant decomposition mechanisms and microbial influences ...has rapid developed, it is curious that plant decomposition models have remained stagnant at the single-stage model from 50 years ago, without endeavor to consider any important factors.
Our research conducted in-situ experiments and identified the optimal metrics for decomposition-related microbes, thereby establishing models for microbial impacts on decomposition rates (k_RDR). Using backward elimination in stepwise regression, we found that the optimal subset of independent variables—specifically Gammaproteobacteria-Q-L, Actinobacteriota-Q-L, and Ascomycota-Q-L—increased the adjusted R-squared (Ra2) to 0.93, providing the best modeling for decomposition rate (p = 0.002). Additionally, k_RDR can be modeled by synergic parameters of ACHB-Q-L, LDB-Q-L, and AB-Q-L for bacteria, and SFQ for fungi, albeit with a slightly lower Ra2 of 0.7–0.9 (p < 0.01). The primary contribution of our research lies in two key aspects. Firstly, we introduced optimal metrics for modeling microbes, opting for debris surface microbes over sediment microbes, and prioritizing absolute abundance over relative abundance. Secondly, our model represents a noteworthy advancement in debris modeling. Alongside elucidating the focus and innovative aspects of our work, we also addressed existing limitations and proposed directions for future research.
This study explores optimum metrics for decomposition-related microbes, offering precise microbial models for enhanced lake nutrient cycle simulation.
Display omitted
•Macrophyte decomposition is crucial for nutrient cycles in MDE lakes.•Modeling microbial impacts on decomposition is crucial yet constrained.•We conducted in-situ comparative experiments across 13 sub-lakes in a MDE lake.•Optimal metrics for decomposition-related microbe were explored.•Precise microbial models were developed to enhance nutrient cycle simulations.
Increasing the ceftaroline fosamil dose beyond 600 mg every 12 h may provide additional benefit for patients with complicated skin and soft tissue infections (cSSTIs) with severe inflammation and/or ...reduced pathogen susceptibility. A Phase III multicentre, randomized trial evaluated the safety and efficacy of ceftaroline fosamil 600 mg every 8 h in this setting.
Adult patients with cSSTI and systemic inflammation or comorbidities were randomized 2:1 to intravenous ceftaroline fosamil (600 mg every 8 h) or vancomycin (15 mg/kg every 12 h) plus aztreonam (1 g every 8 h) for 5-14 days. Clinical cure was assessed at the test of cure (TOC) visit (8-15 days after the final dose) in the modified ITT (MITT) and clinically evaluable (CE) populations. Non-inferiority was defined as a lower limit of the 95% CI around the treatment difference greater than -10%. An MRSA-focused expansion period was initiated after completion of the main study. Clinicaltrials.gov registration numbers NCT01499277 and NCT02202135.
Clinical cure rates at TOC demonstrated non-inferiority of ceftaroline fosamil 600 mg every 8 h versus vancomycin plus aztreonam in the MITT and CE populations: 396/506 (78.3%) versus 202/255 (79.2%) patients (difference -1.0%, 95% CI -6.9, 5.4) and 342/395 (86.6%) versus 180/211 (85.3%) patients (difference 1.3%, 95% CI -4.3, 7.5), respectively. In the expansion period, 3/4 (75%) patients treated with ceftaroline fosamil were cured at TOC. The frequency of adverse events was similar between groups.
Ceftaroline fosamil 600 mg every 8 h was effective for cSSTI patients with evidence of systemic inflammation and/or comorbidities. No new safety signals were identified.
•VR interventions improve physical function, balance and minimize falls in elderly.•Balance training-based VR intervention is more effective in balance.•The plan with 20–45 min, 5–8 wk, and ≥3 ...times/wk has significantly effects.•VR intervention is more effective in elderly populations in hospitals or nursing homes.
In recent years, sports games based on virtual reality (VR) have been widely used in the prevention and treatment of diseases related to the elderly. However, there seems to be no consensus on the improvement and comparison of physical function, balance and falls in elderly people with balance impairment.
This study aims to explore the effects of VR intervention on physical function, balance and falls in elderly people with balance impairment.
Systematic literature searches of the PubMed, Web of Science, Elsevier, Cochrane, CNKI, and Wanfang databases were performed for VR games-related randomized controlled trials or comparison studies among elderly participants with impaired balance, published in English or Chinese until March 20, 2022. The Cochrane collaboration risk of bias tool was used to evaluate the methodological quality of the studies. A meta-analysis was performed to calculate the standardized mean deviation or mean difference of the sample and its 95% confidence interval (CI) in VR games.
The systematic review included 23 studies. The results showed that VR intervention had significant effects on hand grip strength (MD:1.30, P = 0.040), knee extension strength (MD:-6.27, P<0.001), five times sit-to-stand test scores (MD:1.13, P = 0.030), timed up-and-go test scores (MD:-1.01, P = 0.001), berg balance scale scores (MD:2.37, P<0.001), and falls efficacy scale scores (SMD:-0.28, P = 0.020). Subgroup analysis results showed that VR intervention was more effective on improving TUG and BBS scores than the conventional exercise group (MD=-0.54, P = 0.004; MD=3.24, P<0.001) and the non-intervention group (MD=-0.98, P = 0.001; MD=3.30, P < 0.001). The balance training-based VR had a significant effect on improving TUG (MD=-1.03, P = 0.004) and BBS (MD=2.93, P<0.001), and 20–45 min intervention, ≥3 times/wk, 5–8 wk cycles were significant in improving TUG (MD=-0.89, P<0.001; MD=-0.75, P = 0.0003; MD=-1.54, P<0.0001). VR intervention significantly improved TUG (MD=-2.27, P<0.0001) and BBS (MD=3.41, P<0.0001) in older adults in the hospital or nursing home compared with those residing in communities.
VR interventions can help the elderly with impaired balance to overcome traditional sports obstacles and improve physical function, balance and minimize falls. Balance training-based VR intervention is more effective in balance recovery and fall prevention compared with game program. An intervention plan comprising 20–45 min, 5–8 wk cycles, and ≥3 times/wk frequency has significantly higher effects for high-risk elderly populations living in hospitals or nursing homes.
Distributed energy is a crucial breakthrough and focus for the green and low-carbon transformation of rural energy in China. It has experienced rapid development in recent years. However, mismatches ...between rural energy production and consumption capacities, and between the unregulated construction of distributed energy systems and the capacity of rural power grids, have become increasingly severe. These issues are hindering the establishment of a new energy system and the modernization of rural areas. This paper addresses the problems and challenges faced in the development of rural energy in China. Through an investigation and analysis of the experiences and shortcomings in the development and utilization of distributed energy in Northern China, the paper proposes measures and suggestions to promote the scientific development of distributed energy in rural China.
High-performance electromagnetic (EM) wave absorption property could be achieved by architecture design of nanomaterials. Herein, two layer hybrid Co0.2Fe2.8O4/carbon nanofibers with porous ...three-dimensional (3D) hierarchical structure were synthesized successfully through facile electrospinning, carbonization and mild chemical treatment. The Co0.2Fe2.8O4 particles grew along the carbon nanofibers, forming the enhanced heterogeneous interfaces and high specific areas. As expected, the EM wave absorbent showed an excellent absorbing capability. The composites achieved a maximum reflection loss (RL) of −43.45 dB at 11.1 GHz with thickness of 3.0 mm. More importantly, the effective bandwidth (RL ≤ −10dB) was 5.85 GHz, covering 30% of the entire measured bandwidth. The absorption intensity and bandwidth were superior to other typical CoFe-based composites. The intrinsic mechanism of the absorption revealed that the polarization losses, magnetic losses, magnetic natural resonance and exchanged resonance losses contributed to the high-performance microwave absorption. Moreover, good impedance matching and complex transmission paths that generated from unique porous network also played an important role. This study is expected to guide future exploration on designing and synthesizing high performance EM wave absorbents.
Clinical practice guidelines or recommendations often require timely and regular updating as new evidence emerges, because this can alter the risk-benefit trade-off. The scientific process of ...developing and updating guidelines accompanied by adequate implementation can improve outcomes. To promote better management of patients receiving vancomycin therapy, we updated the guideline for the therapeutic drug monitoring (TDM) of vancomycin published in 2015.
Our updated recommendations complied with standards for developing trustworthy guidelines, including timeliness and rigor of the updating process, as well as the use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. We also followed the methodology handbook published by the National Institute for Health and Clinical Excellence and the Spanish National Health System.
We partially updated the 2015 guideline. Apart from adults, the updated guideline also focuses on pediatric patients and neonates requiring intravenous vancomycin therapy. The guideline recommendations involve a broadened range of patients requiring TDM, modified index of TDM (both 24-hour area under the curve and trough concentration), addition regarding the necessity and timing of repeated TDM, and initial dose for specific subpopulations. Overall, 1 recommendation was deleted and 3 recommendations were modified. Eleven new recommendations were added, and no recommendation was made for 2 clinical questions.
We updated an evidence-based guideline regarding the TDM of vancomycin using a rigorous and multidisciplinary approach. The updated guideline provides more comprehensive recommendations to inform rational and optimized vancomycin use and is thus of greater applicability.
Nitrogen accumulation in sediments, and the subsequent migration and transformations between sediment and the overlying water, plays an important role in the lake nitrogen cycle. However, knowledge ...of these processes are largely confined to ice-free seasons. Recent research under ice has mainly focused on the water eco-environmental effects during winter. Sediment N accumulation during the ice-on season and its associated eco-environmental impacts have never been systematically investigated. To address these knowledge gaps, we chose Wuliangsu Lake in China as a case study site, taking advantage of the spatial disparity between the 13 semi-separated sub-lakes. Based on samples of 35 sampling sites collected before, in the middle, and at the end of ice-on season separately, we performed a quantitative analysis of under-ice lake N accumulation and water-sediment N exchange by analyzing N fraction variations. Hierarchical Cluster Analysis and Relevance Analysis were used to help elucidate the main causes and implications of under-ice N variation. Our results clearly show that existing studies have underestimated the impact of under-ice N accumulation on the lake ecology throughout year: 1) Sediment N accumulated 2–3 times more than that before winter; 2) residual nitrogen (Res-N) contributed to the majority of the accumulated sediment N and was mainly induced by the debris of macrophytes; 3) total available nitrogen (TAN) was the most easily exchanged fractions between sediment and water, and it mainly affected the water environment during winter; 4) the Res-N accumulation during the ice-on season may have a strong impact on the eco-environment in the subsequent seasons. Our research is valuable for understanding the mechanism of internal nutrient cycle and controlling the internal nitrogen pollution, especially in shallow seasonally-frozen lakes that have long suffered from macrophyte-phytoplankton co-dominated eutrophication.
Display omitted
•Previous knowledge has underscored the impacts of under-ice nitrogen accumulation.•Under-ice sediment nitrogen cumulated 2–3 times more than that before ice-on season.•Residual nitrogen (Res-N) contributed to the majority of accumulated sediment N.•Accumulated Res-N was mainly induced by the debris of macrophytes.•Res-N accumulation may have a strong impact on eco-environment in subsequent seasons.
Under-ice sediment N cumulated 2–3 times more than that before ice-on season. The existing studies have underestimated the eco-environment impact of under-ice N accumulation.
Research objectives: specify the framework of using cutting-edge approaches and innovations in the training of rehabilitation physicians; investigate existing innovative technologies; get an insight ...into the motivation of students majoring in rehabilitation when working with the Gross simulator in sports rehabilitation of patients. The research was conducted at a mixed-type rehabilitation center for disabled adults and children at Soochow University in China. The study was conducted among 200 students majoring in rehabilitation at Soochow University and 100 children from a rehabilitation center with motor disorders: 50 boys and 50 girls. The patients were aged 4-6 years, and the average age of the participating students was 21 years. The students were offered a 6-month training course in rehabilitation of patients with musculoskeletal disorders, by using innovative technology—the Gross simulator. Student motivation analysis yielded the following outcomes: 90% of the students said that training to operate simulators is useful for the rehabilitation specialist, because this affects the proficiency of such specialist; 15% of students reported they did not like innovative technology in teaching because they faced difficulties in understanding it; 80% of students believed such technology facilitated the learning, and 5% of students were neutral. Further studies, conducted on clinical research sites, might address the effectiveness of training rehabilitation specialists, the use of cutting-edge simulators and robotic systems, as well as development of rehabilitation protocols for patients with injuries and musculoskeletal disorders.
Macrophyte overgrowth in eutrophic lakes can hasten the decline of shallow water bodies, yet the impact of macrophyte deposition on sediment phosphorus (P) accumulation in the ice-on season remains ...unclear. Comparative analyses of P variations among 13 semi-connected sub-lakes in Wuliangsu Lake in China, a typical MDE lake, considered external flow and macrophyte decomposition as driving forces. Sediment P fractions and water total phosphorus (TP) were analyzed at 35 sampling points across three ice-on season stages, along with macrophyte TP content to assess debris contributions.
Our findings reveal that phosphorus accumulation occurs during the ice-on season in the MDE lake, with an average TP content increase of 16 mg/kg. However, we observed a surprisingly small sediment nutrient accumulation ratio (ΔTP/ΔTN=0.006) compared to macrophyte nutrient levels before decomposition. Further analysis of the dominant species, Potamogeton pectinatus, indicates that a significant portion (55%) of macrophyte phosphorus is released before the ice-on season. This highlights the critical importance of timing macrophyte harvesting to precede the phosphorus leaching process, which has implications for lake management and ecosystem restoration efforts.
Additionally, our research demonstrates similar transformations among different sediment fractions as previously reported. Macrophyte debris decomposition likely serves as the primary source of Residual P (Res-P) or TP accumulation. In addition, Ca-bound P (Ca–P) generally showed a decrease, which mainly caused by its transformation to Fe/Al-bound P (Fe/Al–P), Exchange-P (Ex-P), and sometimes to Res-P. However, we emphasize the significant impacts of flow dynamics on Ca–P transport and transformations. Its hydrodynamic action increases water dissolved oxygen, which accelerates the transformation of Ca–P to more easily released Fe/Al–P and Ex-P. Furthermore, hydrodynamic transport also leads to upstream Ca–P transport to downstream. This underscores the necessity of considering flow dynamics when estimating phosphorus variations and formulating phosphorus restoration strategies.
Display omitted
•Phosphorus (P) cycle in macrophyte-dominated eutrophic lakes remain understudied.•Comparatively analyzing P variations among 13 sub-lakes during ice-on season.•Residual P contributes to the P accumulation caused by macrophyte decomposition.•Fifty-five percent macrophyte P have been leached before the ice-on season.•Macrophyte harvesting remains necessary but should be done before P leaching.
PDF
