Objective To summarize the development of gallbladder carcinoma related resistance genes and targeted therapy. Methods Domestic and international publications online involving resistance genes and targeted therapy of gallbladder carcinoma in recent years were collected and reviewed. Results Recent studies had shown that chemotherapy drug resistance of gallbladder carcinoma mainly involved lysosome protein transmembrane β4 （LAPTM4B） gene， NF-E2-related factor 2 （Nrf2） gene， and cancer stem cells （CSCs）. While the latest gene targets of treatment for gallbladder carcinoma mainly involved LAPTM4B， Nemo-like kinase （NLK）， tissue factor way inhibitor-2 （TFPI-2）， vascular endothelial growth factor-D （VEGF-D）， epidermal growth factor receptor （EGFR）， and melanoma differentiation-associated gene 7/interleukin 24 （mda-7/IL-24） gene. Conclusion The research involving resistance genes and targeted therapy of gallbladder carcinoma has make a certain progress， which broaden the concept of traditional treatment of gallbladder carcinoma.
Objective To evaluate the influence on the estimation of respiratory mechanics with dynamic signal analysis approach during noninvasive positive pressure ventilation (NPPV) under different inspiratory effort conditions. Methods The Respironics V60 ventilator was connected to a ASL5000 lung simulator, which simulate lung mechanics in healthy adults with body weight from 65 to 70 kg, and patients with chronic obstructive pulmonary disease (COPD) and acute respiratory distress (ARDS). Each lung models was subjected to 4 different muscle pressures (Pmus): 0, 5.0, 10.0, and 15.0 cm H2O. Inspiratory pressure support level was adjusted to maintain tidal volume (VT) achieving 7.0 mL/kg outputted by ventilator respectively. Positive end expiratory pressure was set at 5.0 cm H2O and back-up rate was 10 beats per minute. Measurements were conducted at system leaks with 25 to 28 L/min. The respiratory system compliance (Crs), inspiratory and expiratory resistance (Rinsp and Rexp) were estimated by special equations, which was derived from the exhaled VT, flow rate and airway pressure. Results The driving pressure (DP) was decreased with Pmus increasing, and was 1.0 cm H2O after Pmus exceeding 10.0 cm H2O and the VT was larger than 7.0 mL/kg in normal adult model. The estimated value of Crs was affected by the changes of Pmus in all three lung models. The significant underestimation of Raw and the overestimation of Crs were observed when Pmus level exceed 10.0 cm H2O. The measured errors of Crs and Rexp were within 10% in COPD and ARDS model when Pmus was at 5.0 cm H2O. The underestimation of Rinsp was always existed in all Pmus level (P<0.01). Conclusions Using dynamic signal analysis approach, the real-time estimation of respiratory mechanics (Crs and Raw) is no need to interrupt the spontaneous breathing during NPPV. Excessive effort will increase the patient’s inspiratory workload, which is not benefit to accurate estimation of respiratory mechanics.
ObjectiveTo investigate the species and resistance phenotypes of the pathogens causing catheter-associated urinary tract infection (CAUTI) in critically ill patients in West China Hospital of Sichuan University, and to provide the basis for the prevention and treatment of this kind of infection. MethodsThe clinical data and findings of the laboratory examination of the patients, who were admitted to intensive care units and suffered from CAUTI in our hospital during January 2012 to December 2014, were retrospectively analyzed. The pathogens isolates from the urine specimens of the patients with CAUTI and their resistance phenotypes were analyzed. ResultsThree hundred and seventy patients suffering from CAUTI were included in this study. Five hundred and seventeen strains of pathogens were isolated from the urine specimens of these patients, including 222 isolates (42.9%) of fungus, 181 isolates (35.0%) of gram negative bacteria, and 114 isolates (22.0%) of gram positive bacteria. In terms of species distribution, Candida albicans (105 isolates, 20.3%), C.glabrata (78 isolates, 15.1%) and C.glabrata (30 isolates, 5.8%) were the predominant fungus. Among the gram negative bacteria, Escherichia coli (81 isolates, 15.7%), Klebsiella pneumoniae (37 isolates, 7.2%), and Acinetobacter calcoaceticus-baumannii complex (23 isolates, 4.4%) were the main species. Enterococcus faecium (79 isolates, 15.3%) and E.faecalis (13 isolates, 2.5%) were the frequently isolated gram positive bacteria. Analysis of the resistance phenotype showed that the resistance rates to itraconazole, voriconazole and fluconazole of Candida spp. were above 10%. Thirty percent of the isolates of E.coli and K.pneumoniae, and 60% of the isolates of A.calcoaceticus-Baumannii complex were resistant to many of the regular antibiotics. Imipenem resistance rate of A.calcoaceticus-Baumannii complex was 60.8%. Sixty percent of the isolates of E.faecium and E.faecalis were resistant to many of the regular antibiotics. The vancomycin-resistant isolates accounted for 16.5% of E.faecium and 31.0% of E.faecalis. ConclusionCandida species are the major pathogens for CAUTI in critically ill patients in our hospital and show the resistance to azoles. We should focus on the drug resistance of gram negative bacteria and gram positive bacteria. The rational use of antibiotics and application of effective infection control measures are important to decrease the CAUTI.
Peptidoglycan is an important component of bacterial cell wall, which plays an important role in maintaining the integrity of bacterial cell structure, stimulating immune response, and anti-infection. Peptidoglycan recycling is an indispensable process for bacterial cell growth and reproduction. In recent years, it has been reported that the peptidoglycan recycling is closely related to the occurrence and development of bacterial resistance, especially with the antibacterial activity of β-lactam antibiotics. In this paper, the relationship between peptidoglycan recycling and resistance is described by combining relevant reports and taking Mycobacterium tuberculosis and Pseudomonas aeruginosa as examples, so as to promote the understanding of bacterial resistance mechanisms and provide potential targets for the development of new antimicrobial drugs.
ObjectiveTo understand the clinical distribution and drug resistance of Klebsiella pneumoniae in Yibin during 2011 to 2014 so as to provide evidence for clinical rational use of antimicrobial drugs. MethodsKlebsiella pneumoniae isolated from all types of clinical specimens were collected from the First People's Hospital and the Second People's Hospital of Yibin during 2011 to 2014. VITEK2 Compact and its supporting identification card GP and drug sensitivity test card AST-GP67 were used for detection, and the results were analyzed and summarized. ResultsMost Klebsiella pneumoniae were detected from the Department of Respiratory Medicine, the proportion for each year was 48.15%, 46.24%, 45.44%, and 44.97% during 2011 to 2014. Klebsiella pneumoniae isolated were mainly from sputum samples, the proportion for each year was 81.01%, 89.18%, 87.80%, and 83.52% between 2011 and 2014. Imipenem and piperacillin/tazobactam resistance rates were lower, but the overall trend was rising. Ampicillin/sulbactam, and sulfamethoxazole resistance rates were higher. Levofloxacin, ciprofloxacin increased year by year. Aztreonam, cefepime, and amikacin rate declined. ConclusionKlebsiella pneumoniae is one of the main infection pathogen in the Department of Respiratory Medicine. Klebsiella pneumoniae resistance rates are higher. Klebsiella pneumoniae were sensitive to enzyme inhibitors β-lactam antimicrobial agents and carbapenem antibiotics.
Objective To investigate the characteristics of the pathogens causing bloodstream infection after general surgery in infant and young children patients, and to provide the references for disease treatment and nosocomial infection control. Methods The clinical and laboratory examination data after general surgery in infant and young children patients, who were admitted to our hospital from January 2012 to March 2017, were retrospectively collected. The pathogens and drug resistance were analyzed by SPSS 18.0 software. Results In this study, 109 cases were included, and 117 strains of the pathogens were isolated, including 53 isolates (45.3%) of gram negative bacteria, 41 isolates (35.0%) of gram positive bacteria, and 23 isolates (19.7%) of fungi. Escherichia coli (16/117, 13.7%), Enterococcus faecium (13/117, 11.1%), Candida parapsilosis (12/117, 10.3%), Klebsiella pneumoniae (9/117, 7.7%) and Enterococcus faecalis (8/117, 6.8%) were the top 5 species. Strains producing extended-spectrum beta-lactamase accounted for 87.5% of E. coli (14/16) and 44.4% (4/9) of K. pneumoniae isolates. Both E. faecium and E. faecalis were susceptible to vancomycin. C. parapsilosis showed the susceptibility to the antifungal agents. Conclusion Gram negative bacteria are predominant pathogens causing bloodstream infection after general surgery in infant and young children patients, and infection caused by resistant isolates should be prevented and controlled.
Objective To analyze the species distribution and resistance of the pathogens isolated fromblood cultures of the patients in intensive care unit ( ICU) , and provide a basis for prevention and control of bloodstream infections in critically ill patients. Methods The data of blood cultures of the patients in ICUduring January 2009 to December 2011 was investigated retrospectively.Results In the last 3 years, positive rate of blood cultures of ICU patients was 15. 4% , 15. 7% , and 17. 6% respectively. Among the isolates, Gram-positive bacteria were predominant ( 52. 3% ) , followed in order by gram-negative bacteria ( 33. 1% ) and fungi ( 14. 7% ) . Aerobe and facultative anaerobe were the predominant bacterial isolates ( 99. 7% ) . Enterococcus faeciumand Staphylococcus spp. were the most common gram-positive bacteria, and 4. 5% of E. faecium isolates were resistant to vancomycin. Rate of methicillin-resistance for S. aureus and S. epidermidis was 73. 5% and 93. 7% respectively. In terms of gram-negative bacteria, Acinetobacter calcoaceticus- A. baumannii complex were the leading species, 96. 9% of the isolates had multi-drug resistance and 14. 1% of the isolates had extra-drug resistance. Klebsiella pneumonia and Escherichia coli isolates were less frequently isolated and those producing extended spectrum beta-lactamases accou ted for 70. 3% and 80. 0% of the isolates respectively. Candida spp. was the most common fungi isolates ( 96. 7% )with an annual change of species distribution and declining susceptibility to azoles.Conclusions Gram-positive bacteria should be the major target for prevention and control of bloodstream infections in critically ill patients. Whereas, more attention should be paid to the infection caused by candida spp. and multidrug resistant gram-negative bacteria.
Objective To systematically review the resistance of pseudomonas aeruginosa to quinolone in China. Methods Such databases as CNKI, WanFang Data, CBM, VIP, PubMed, EMbase and The Cochrane Library were electronically searched from inception to December 2012, for relevant studies on the resistance mechanism of pseudomonas aeruginosa to quinolone. Two reviewers independently screened literature according to inclusion and exclusion criteria. Then, meta-analysis was performed using RevMan 5.0 software. Results Totally 19 studies were included, involving 723 strains of quinolone-resistant pseudomonas aeruginosa. The statistical results showed that, in the areas to the north of Huai River, the detection rates of gyrA, gyrB, parC and parE were 88.0%, 13.3%, 31.4% and 16.7%, respectively; and in the areas to the south of Huai River, they were 64.6%, 50.0%, 35.4% and 16.7%, respectively. The detection rates of plasmid mediated resistant genes aac (6’)-Ib-cr was 0 (0/66) in the areas to the north of Huai River, and 39% (25/64) in the areas to the south of Huai River. The outer membrane protein expression rate of active efflux system was 68.1%. Conclusion In China, gyrA gene mutation and the active efflux system mainly account for pseudomonas aeruginosa’s resistance to quinolone. DNA topoisomerase IV abnormalities and plasmid mediated resistance is the secondary mechanism.
Objective To assess the improvement of different resistance training regimens on blood lipid metabolism and insulin resistance in patients with type 2 diabetes mellitus (T2DM). Methods PubMed, ProQuest, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP databases were searched to collect randomized controlled trials of resistance training intervention to improve blood lipids and insulin resistance in patients with T2DM. The search time range was from the establishment of the databases to May 2023. Two reviewers assessed the risk of bias of the included studies using the Physiotherapy Evidence Database scale, and performed a network meta-analysis of the extracted data using Stata 16.0 software. Results In the end, 24 articles were included, and a total of 983 participants were enrolled. The result of network meta-analysis showed that high-frequency and moderate-intensity resistance exercise significantly improved the levels of insulin resistance [standardized mean difference=−1.71, 95% confidence interval (CI) (−2.75, −0.67)], triglycerides [weighted mean difference (WMD)=−0.27 mmol/L, 95%CI (−0.51, −0.04) mmol/L], and total cholesterol [WMD=−0.16 mmol/L, 95%CI (−0.20, −0.12) mmol/L], but had no significant effect on improving the level of high-density lipoprotein [WMD=0.05 mmol/L, 95%CI (−0.02, 0.11) mmol/L] or low-density lipoprotein [WMD=−0.20 mmol/L, 95%CI (−0.42, 0.03) mmol/L]. The results of cumulative probability ranking showed that high-frequency and moderate-intensity resistance exercise was the best in improving insulin resistance, triglycerides, high-density lipoprotein and low-density lipoprotein levels. Conclusion Based on current evidence, high-frequency and moderate-intensity resistance exercise may be the best resistance exercise regimen to improve insulin resistance and lipid metabolism in patients with T2DM.
ObjectiveTo explore the effects of different exercise methods on serum short-chain fatty acids (SCFA) in type 2 diabetic mice, determine the best exercise method to improve SCFAs in type 2 diabetic mice, and provide a theoretical basis for the preventive intervention for patients with early diabetes.MethodsAccording to different exercise methods, 48 8-week-old male db/db type 2 diabetic mice were randomly divided into four groups, including aerobic exercise group, resistance exercise group, combined resistance- aerobic exercise (referred to as combined exercise) group, and the control group; with 10 mice in each group and another 2 as the substitutes. The mice were fed in the same manner in each group. The control group did not perform exercise intervention, the aerobic exercise group performed weightless running exercise, the resistance exercise group performed tail weight-bearing ladder exercise, and the combined exercise group alternated aerobic exercise and resistance exercise. Blood glucose and body weight were measured before and 8 weeks after the intervention. The content of serum SCFAs in mice was determined by gas chromatography-mass spectrometry.ResultsA total of 40 mice completed the experiment successfully. Before the exercise intervention, there was no significant difference in blood glucose or weight among the groups (P>0.05). After 8 weeks of exercise intervention, the blood glucose and weight in each exercise group were significantly lower than those in the control group (P<0.05), and the blood glucose and weight in the combined exercise group were significantly lower than those in the aerobic exercise group and the resistance exercise group (P<0.05). The contents of SCFA were higher in the aerobic exercise group, resistance exercise group, and combined exercise group than those in the control group (P<0.05); the contents of acetic acid and butyric acid in the combined exercise group were better than those in the aerobic exercise group (P<0.05), and the contents of propanoic acid and valeric acid in the combined exercise group were better than those in the resistance exercise group (P<0.05).ConclusionsDifferent exercise methods can improve the SCFA content in serum of type 2 diabetic mice. Compared with aerobic exercise and resistance exercise, combined exercise has the best effect in improving SCFA.