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Although immune checkpoint inhibitors (ICIs) have produced remarkable responses in non-small cell lung cancer (NSCLC) patients, receivers still have a relatively low response rate. Initial response assessment by conventional imaging and evaluation criteria is often unable to identify whether patients can achieve durable clinical benefit from ICIs. Overall, there are sparse effective biomarkers identified to screen NSCLC patients responding to this therapy. A lot of studies have reported that patients with specific gene mutations may benefit from or resist to immunotherapy. However, the single gene mutation may be not effective enough to predict the benefit from immunotherapy for patients. With the advancement in sequencing technology, further studies indicate that many mutations often co-occur and suggest a drastic transformation of tumour microenvironment phenotype. Moreover, co-mutation events have been reported to synergise to activate or suppress signalling pathways of anti-tumour immune response, which also indicates a potential target for combining intervention. Thus, the different mutation profile (especially co-mutation) of patients may be an important concern for predicting or promoting the efficacy of ICIs. However, there is a lack of comprehensive knowledge of this field until now. Therefore, in this study, we reviewed and elaborated the value of cancer mutation profile in predicting the efficacy of immunotherapy and analysed the underlying mechanisms, to provide an alternative way for screening dominant groups, and thereby, optimising individualised therapy for NSCLC patients.
We aimed to describe the clinical features in coronavirus disease 2019 (COVID-19) cases. We studied 134 critically ill COVID-19 cases from 30 December 2019 to 20 February 2020 in an intensive care unit (ICU) at Wuhan Jinyintan Hospital. Demographics, underlying diseases, therapy strategies and test results were collected and analysed from patients on admission, admission to the ICU and 48 h before death. The non-survivors were older (65.46 (s.d. 9.74) vs. 46.45 (s.d. 11.09)) and were more likely to have underlying diseases. The blood group distribution of the COVID-19 cases differed from that of the Han population in Wuhan, with type A being 43.85%; type B, 26.92%; type AB, 10% and type O, 19.23%. Non-survivors tend to develop more severe lymphopaenia, with higher C-reactive protein, interleukin-6, procalcitonin, D-dimer levels and gradually increased with time. The clinical manifestations were non-specific. Compared with survivors, non-survivors more likely to have organ function injury, and to receive mechanical ventilation, either invasively or noninvasively. Multiple organ failure and secondary bacterial infection in the later period is worthy of attention.
During the detection of industrial hazardous gases, like formaldehyde (HCHO), the selectivity is still a challenging issue. Herein, an alternative HCHO chemosensor that based on the tin oxide nanoparticles is proposed, which was obtained through a facile hydrothermal method. Gas sensing performances showed that the optimal working temperature located at only 180 °C, the response value of 79 via 50 ppm HCHO was much higher than that of 35 at 230 °C. However, the compromised test temperature was selected as 230 °C, taking into account the faster response/recovery speeds than 180 °C, named 20/23versus 53/60 s, respectively. The response (35) of the SnO2 nanoparticles-based sensor to 50 ppm of HCHO is about 400% higher than that of bulk SnO2 sensor (9), especially when the gas concentration is 1 ppm, SnO2 nanoparticles also has a higher sensitivity which may possibly result from more exposed active sites and small size effect for nanoparticles than for bulk ones. The gas sensor based on SnO2 nanoparticles can be utilized as a promising candidate for practical low-temperature detectors of HCHO due to its higher gas response, excellent response–recovery properties, and perfect selectivity.
The present study explored the mechanism of Zn-methionine (Zn-Met) influencing eggshell quality of laying hens and investigated whether the mechanism was related to Ca deposition. Hyline grey layers (n 384, 38 weeks old) were divided into four groups: 0 mg Zn/kg, 40, 80 mg Zn/kg as Zn-Met, and 80 mg Zn/kg as zinc sulphate (ZnSO4). Eggshell quality, Zn contents, Zn-containing enzyme activities and expressions of shell matrix proteins in eggshell gland (ESG) were analysed. Zn-Met treatment at 80 mg/kg increased (P < 0·05) egg weight and eggshell strength throughout the experiments. The 80 mg/kg Zn-Met group (P < 0·05) had decreased mammillary knob width and larger relative atomic weight percentage of Ca, stronger signal intensity of Ca in linear distribution and the Ca was more evenly distributed in the transversal surface of eggshell. Zn contents (P < 0·001) in yolk and serum, Ca, albumin (Alb) levels in ESG as well as carbonic anhydrase (CA) activity in serum (P < 0·05) and mRNA levels of CA and Ca-binding protein-d28k (CaBP-D28k) (P < 0·001) in the 80 mg/kg Zn-Met group were the highest among all treatments. In conclusion, shell strength as one of eggshell qualities was mostly related to mammillary cone width in ultrastructure caused by the pattern of Ca deposition in eggshell formation. Also, the increase in Zn-Met-induced Ca deposition may be due to the increased Zn contents in serum and tissues, which were attributable to the increased CA concentrations in serum, Ca, Alb levels and up-regulated CA and CaBP-D28k mRNA levels in ESG.
Drug overuse in healthcare settings is common in China. Clinical pathways are tools that provide the link between the best available evidence and clinical practice. This study aimed to determine if the clinical pathway of community-acquired pneumonia (CAP) had effects on the antibiotic use in patients with CAP.
The study was conducted in Shanghai, Hubei Province, and Gansu Province to represent high, middle, and low levels of socioeconomic status in 2015. In each region, three public tertiary general hospitals and three public secondary general hospitals were selected for chart review of antibiotics’ utilization in the patients with CAP during 2014. A multilevel logistic regression model was used in the study, with a dependent variable of appropriate utilization of antibiotics (right time, right type, and right combined use) and independent variables of hospital adoption of clinical pathway and patient characteristics (sex, age, severity of disease, and number of comorbidities).
Twelve surveyed hospitals (66.67 percent) adopted CAP clinical pathways and 354 cases (66.29 percent) were from these twelve hospitals (CP group). Among the total utilization of antibiotics (796 times) in eighteen types of antibiotics used in patients with CAP, the five recommended types of antibiotics accounted for 82.16 percent.
The percentages of cases that got initial antibiotics in time were 90.60 percent in the CP group and 76.11 percent in the non-CP group. The compliance rate for appropriate types of antibiotic utilization was 88.36 percent in CP group, much higher than that in non-CP group (70.22 percent). For 244 cases that used combined antibiotics, the compliance rate for the recommended combinations of antibiotics was 20.12 percent in the CP group, but 1.25 percent in the non-CP group. After controlling patients’ characteristics, the patients in the CP group got more appropriate antibiotics than those in the non-CP group.
Adoption of the CAP clinical pathway in hospitals can improve antibiotics' utilization.
The Centers for Disease Control and Prevention (CDC) has developed an approach to ventilator-associated events (VAE) surveillance. Using these methods, this study was performed to investigate VAE incidences and to test whether VAEs are associated with poorer outcomes in China.
A 4-month, prospective multicenter surveillance study between April and July 2013.
Our study included 15 adult intensive care units (ICUs) of 15 hospitals in China.
Patients admitted to ICUs during the study period
Patients on mechanical ventilation (MV) were monitored for VAEs: ventilator-associated conditions (VACs), infection-related ventilator-associated complications (IVACs), and possible or probable ventilator-associated pneumonia (VAP). Patients with and without VACs were compared with regard to duration of MV, ICU length of stay (LOS), overall hospital LOS, and mortality rate.
During the study period, 2,356 of the 5,256 patients admitted to ICUs received MV for 8,438 ventilator days. Of these patients, 636 were on MV >2 days. VACs were identified in 94 cases (4.0%; 11.1 cases per 1,000 ventilator days), including 31 patients with IVACs and 16 with possible VAP but none with probable VAP. Compared with patients without VACs, patients with VACs had longer ICU LOS (by 6.2 days), longer duration on MV (by 7.7 days), and higher hospital mortality rate (50.0% vs 27.3%). The mortality rate attributable to VACs was 11.7%. Compared with those with VACs alone, patients with IVACs had longer duration on MV and increased ICU LOS but no higher mortality rates.
In China, surveillance of VACs and IVACs is able to identify MV patients with poorer outcomes. However, surveillance of possible and probable VAP can be problematic.
Infect. Control Hosp. Epidemiol. 2015;36(12):1388–1395
Coronary artery bypass graft (CABG) and primary arthroplasty surgical site infection (SSI) rates are declining slower than other healthcare-associated infection rates. We examined antimicrobial prophylaxis (AMP) regimens used for these operations and compared their spectrum of activity against reported SSI pathogens.
Pathogen distributions of CABG and hip/knee arthroplasty complex SSIs (deep and organ/space) reported to the National Healthcare Safety Network (NHSN) from 2006 through 2009 and AMP regimens (same procedures and time period) reported to the Surgical Care Improvement Project (SCIP) were analyzed. Regimens were categorized as standard (cefazolin or cefuroxime), β-lactam allergy (vancomycin or clindamycin with or without an aminoglycoside), and extended spectrum (vancomycin and/or an aminoglycoside with cefazolin or cefuroxime). AMP activity of each regimen was predicted on the basis of pathogen susceptibility reports and published spectra of antimicrobial activity.
There were 6,263 CABG and arthroplasty complex SSIs reported (680,489 procedures; 880 NHSN hospitals). Among 6,574 pathogens reported, methicillin-sensitive Staphylococcus aureus (23%), methicillin-resistant S. aureus (18%), coagulase-negative staphylococci (17%), and Enterococcus species (7%) were most common. AMP regimens for 2,435,703 CABG and arthroplasty procedures from 3,330 SCIP hospitals were analyzed. The proportion of pathogens predictably susceptible to standard (used in 75% of procedures), β-lactam (12%), and extended-spectrum (8%) regimens was 41%–45%, 47%–96%, and 81%—96%, respectively.
Standard AMP, used in three-quarters of CABG and primary arthroplasty procedures, has inadequate activity against more than half of SSI pathogens reported. Alternative strategies may be needed to prevent SSIs caused by pathogens resistant to standard AMP regimens.
A new continuous sediment core (PY608W-PC; 3.8 m length) for reconstruction of climatic and environmental changes in the southeastern Tibetan Plateau was taken from the eastern part of Lake Pumoyum Co in August 2006. Sediment layers of the lower part of PY608W-PC (380–300 cm depth) were composed mainly of relatively large plant residues (up to ∼3 cm in length) with an admixture of fine sand and sandy silt. The large plant residues disappeared at ∼300–290 cm depth in core PY608W-PC and were replaced by silt-silty clay. The large plant residues from the lower part of PY608W-PC could be aquatic, because the plant residues were extremely enriched in 13C (up to –3.0‰, −5.6 ± 2.3‰ on average). On the other hand, the plant residue concentrates (PRC fractions) from the upper part of the core (290–0 cm in depth) could be terrestrial C3 plants (δ13C = –21.8 ± 1.7‰ on average). Radiocarbon dating was performed on the large plant residues and PRC fractions from the PY608W-PC sediment core, which represented the chronology from ∼19,000 cal BP to present.
Soil samples from an 85-cm-long continuous section (PY608ES) were collected from an island in Lake Pumoyum Co (southeastern Tibetan Plateau, ∼5020 m asl) in August 2006. To estimate past environmental conditions of Lake Pumoyum Co during the Holocene, we analyzed radiocarbon ages, stable carbon isotope compositions, and total organic carbon/total nitrogen (TOC/TN) atomic ratios of the soil samples. The 14C measurements were performed with the Tandetron accelerator mass spectrometry system at the Center for Chronological Research, Nagoya University. The 14C concentration in the surface layer (101 pMC; 5–10 cm soil depth) was nearly modern. A 14C chronology of the sequence indicated that continuous soil development began on the island in Lake Pumoyum Co at ∼5800 cal BP (at 63 cm soil depth, the top of a gravel layer). These results may reflect a decrease in the lake level in the middle Holocene. The age of the obvious lithologic boundary (∼5800 cal BP) corresponds to the end of Holocene climate optimum.
Glacier and lake variations in the Yamzhog Yumco basin in southern Tibet were studied by integrating series of spatial data from topographic maps and Landsat images at three different times: 1980, 1988/90 and 2000. The results indicate that the total glacier area has decreased from 218 km2 in 1980 to 215 km2 in 2000, a total reduction of 3 km2 (i.e. a 1.5% decrease). Glacier recession rates were clearly larger in the 1990s than the 1980s due to the warmer climate. The total lake area decreased by about 67 km2 during 1980–90 and increased by 32 km2 during 1990–2000. It is suggested that change of lake area in the basin was rapid and most likely caused primarily by the change in precipitation and evaporation in the basin, and secondarily by the increased water supply from melting glaciers.
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