Objectives: Carbapenem-resistant Enterobacteriaceae (CRE) is a multidrug-resistant gram-negative bacteria (MDR-GNB) that is rapidly emerging as a life-threatening nosocomial disease in many countries. We sought to identify the risk factors associated with mortality for carriage of CRE in patients at a tertiary-care teaching hospital. Methods: A retrospective observational study was conducted between January 2020 to December 2021 in a tertiary-care teaching healthcare facility, University Malaya Medical Centre in Malaysia. The study included all inpatients aged ≥18 years who had a CRE infection or were colonized during the study period. The genotype was identified by polymerase chain reaction (PCR). Statistical analysis of data including a multivariate logistic regression analysis was conducted using SPSS version 23.0 software. Results: In total, 176 cases of CRE (130 infection and 46 colonized) were identified, and the mortality rate was 31.8%. The main sources of CRE were rectal swab (61.9%), blood (11.9%), and respiratory sources (11.9%). Klebsiella pneumoniae (55.7%) was the predominant species, followed by Escherichia coli (21.6%). Among the isolates, 17.7% were non–CPE-CRE and 82.3% were CPE-CRE: NDM (69.3%) and OXA (10.8%). In multivariate analysis, the factors associated with mortality were older age (OR, 1.040; 95% CI, 1.012–1.069), longer length of stay (OR, 0.974; 95% CI, 0.955–0.994), use of central venous catheter (OR, 0.287; 95% CI, 0.094–0.878), and arterial lines (OR, 0.292; 95% CI, 0.095–0.891). Conclusion: Patients with CRE had a high mortality rate. Older age, longer duration of stay, indwelling CVC and arterial line were independent risk factors for death. Infection prevention and control measures to reduce CRE, such as active surveillance, contact precautions, compliance to intravenous catheter care bundles, healthcare worker education, and hand hygiene adherence, should be implemented.

Objectives: Surgical-site infections (SSIs) cause significant increases in mortality, morbidity, and prolonged hospitalization after cesarean deliveries. We assessed the effectiveness of the implementation of an SSI bundle in reducing postoperative infections in cesarean deliveries in a tertiary-care teaching hospital in Malaysia. Method: We conducted a quality-improvement study on all women who underwent labor and scheduled cesarean sections at the University Malaya Medical Center (UMMC) between May and December 2020. The preintervention period was May–June 2020 and the postintervention period was September–December 2020. Patients were followed for 90 days after their operation. Before the intervention, SSI rates and compliance with prevention practices were documented. A multidisciplinary team was formed, and education regarding the elements of the SSI prevention bundle was conducted before they were implemented. The care bundle focused on monitoring compliance with preoperative bathing, contact time for skin preparation, hair management, and antibiotics prophylaxis given within 60 minutes prior to incision, as well as patient education. Result: With the implementation of the SSI bundle, we observed a significant reduction in the SSI rate by 50%, from 7 per 100 procedures to 2 per 100 procedures. Compared with the preintervention period, overall compliance with bundle elements improved greatly for preoperative bathing (0 vs 95.7%) and contact time for skin preparation (0 vs 98.8%). In the postintervention period, the method of hair removal was documented, compared to no documentation during the preintervention period. The administration of prophylactic antibiotics within 60 minutes prior incision decreased from 99% to 92.3%. Conclusion: Implementation of an SSI prevention bundle successfully reduced the rate of SSI after cesarean section. The SSI prevention bundle together with improvements by multidisciplinary teams and a good patient-safety culture helped reduce SSI rates. Patient education on pre- and postoperative infection prevention also played an important role in reducing this infection rate.

Immune cells play a key role in maintaining renal dynamic balance and dealing with renal injury. The physiological and pathological functions of immune cells are intricately connected to their metabolic characteristics. However, immunometabolism in chronic kidney disease (CKD) is not fully understood. Pathophysiologically, disruption of kidney immune cells homeostasis causes inflammation and tissue damage via triggering metabolic reprogramming. The diverse metabolic characteristics of immune cells at different stages of CKD are strongly associated with their different pathological effect. In this work, we reviewed the metabolic characteristics of immune cells (macrophages, natural killer cells, T cells, natural killer T cells and B cells) and several non-immune cells, as well as potential treatments targeting immunometabolism in CKD. We attempt to elaborate on the metabolic signatures of immune cells and their intimate correlation with non-immune cells in CKD.

High Mountain Asia (HMA) glaciers are critical water reserves for montane regions, which are readily influenced by climate change. The glacier mass balance during 2000–2021 over HMA was estimated by comparing the elevations from ICESat-2 and the NASADEM. Radar penetration depth could be one of the intrinsic error sources in estimating glacier mass balance by using NASADEM. Therefore, we doubled elevation differences between the X-band Shuttle Radar Topography Missions (SRTMs) and NASADEM to estimate the potential error. The spatial characteristics of the altitude-dependent penetration depth can be detected in most sub-regions of HMA. Relatively deep penetrations in the Himalaya (2.3–3.7 m) and Hissar Alay (4.3 m) regions and small penetrations in the south-eastern HMA (1.0 m) were observed. The HMA region experienced a significant mass loss at a rate of −0.18 ± 0.12 m w.e. a−1, in which the Hengduan Shan exhibited the highest mass loss of −0.62 ± 0.10 m w.e. a−1, the West Kun Lun experienced a substantial mass gain of 0.23 ± 0.13 m w.e. a−1, and the Karakoram showed a more or less balance. Our results are in agreement with previous studies that assessed the mass balance of HMA glaciers from different methods.

We report a generation of energetic protons by the interaction of a high-energy electron driving beam with an underdense plasma slab. After an interaction period of approximately 4000 fs, a proton beam with maximum energy greater than 250 MeV can be achieved by applying a driving beam with energy 1.0 GeV to a 200 $\mathrm {\mu }$m plasma slab. Our two-dimensional particle-in-cell simulations also show that the proton acceleration process can be divided into two stages. In the first stage, a strong positive longitudinal electric field appears near the rear boundary of the plasma slab after the driving beam has passed through it. This acceleration process is similar to the target normal sheath acceleration scheme by the interaction between intense pulsed laser with overdense plasma targets. In the second stage, the accelerated protons experience a long-range acceleration process with a two-stream instability between the high-energy driving beam and the proton beam. Further analyses show that this accelerated proton beam is equipped with the property of good collimation and high energy. This scheme presents a new way for proton or ion acceleration on some special occasions.

The objective of this study was to analyze differences in birth weight and overweight/obesity in a Shanghai twin cohort. We also wanted to study their association and explore possible risk factors for the discordance of overweight/obesity within twins. This was an internal case–control study designed for twins. The 2012 Shanghai Twin Registration System baseline survey data of a total of 3417 twin pairs were statistically analyzed using SPSS22 software. Results show that the body mass index (BMI) of the Shanghai twin population increased with age. Twins with a high birth weight had a higher BMI and a higher rate of overweight and obesity; 0- to 6-year-old twins, male twins and dizygotic (DZ) twins had higher rates of overweight/obesity than other groups. The greater the discordant birth weight rate of twins, the more obvious the difference in BMI (p < .05). There was a significant difference in overweight/obesity between twins with a relative difference of birth weight ≥15% in DZ twins (p < .05). DZ twins, male twins and 0- to 6-year-old twins were more likely to be discordant in overweight/obese than others. The discordant birth weight within twins was not a risk factor for discordant overweight/obesity. However, attention should be paid to childhood obesity, and appropriate interventions should be made at the appropriate time. Genetics may play an important role in the occurrence and development of overweight/obesity. In conclusion, discordant growth and development in the uterus early in life may not lead to discordant weight development in the future.

In this article, the electron trapping and acceleration in the wake field driven by an ultrarelativistic hollow electron beam is studied. When the hollow driver injects into plasma, there is a doughnut-shaped electron bubble formed because of the existence of a special ‘backflow’ beam in the centre of the electron bubble. At the same time, there is a transverse convergence of the hollow driver, which leads to the weakening of the backflow beam. This results in a local electron density transition at the rear of the bubble. During this process, there is an expansion of the longitudinal electron bubble size, and a bunch of background electrons is trapped by the wake field at the rear of the bubble. The tracks for the trapped electrons show that there are two sources: one is from the bubble sheath and the other is from the unique backflow beam. In the particle-in-cell simulation where the driving beam has initial energy of $1.0$ GeV per particle, the trapped beam can be accelerated to energy of more than $1.5$ GeV per particle and the corresponding transformer ratio is $1.5$. With the increase of driving beam energy up to $40.0$ GeV, a transformer ratio of $1.4$ still can be achieved. By adjusting the hollow beam density, it is possible to control the trapped beam charge value and beam quality, such as its energy spread and transverse emittance.

X-ray powder diffraction data, unit-cell parameters, and space group for norethisterone enanthate, C27H38O3, are reported [a = 6.191(4) Å, b = 12.711(3) Å, c = 31.396(2) Å, α = 90°, β = 90°, γ = 90°, unit-cell volume V = 2471.16 Å3, Z = 4, ρcal = 1.104 g cm−3, and space group P212121]. All measured lines were indexed and are consistent with the P212121 space group. No detectable impurities were observed.

Strain path changes during clock rolling cause more serious interaction between adjacent grains, resulting in the occurrence of interactive regions (IRs) with random orientations. Furthermore, plenty of new grains with relatively random orientations are introduced by the subsequent annealing of these IRs. The morphology of the IR and the origin of random orientations were therefore investigated in this study, and the electron backscatter diffraction technique was used to characterize crystallographic orientations of nuclei and deformed matrices. A short-time annealing was imposed on a specimen to catch the transient nucleation behaviors. The results indicate that the orientations of nuclei are similar to their surrounding deformed matrices, especially the points with larger local-misorientation. Additionally, the shape of new grains depends on where it forms, and it is suggested that this fact mainly results from the great difference in stored energies between deformed matrices with {111} and {100} orientations.

Gauged river flow records from China generally span only a few decades, which hampers the detection of long-term, decadal- to centennial-scale cycles and trends in streamflow variability. New and updated tree-ring chronologies help reconstructed the water-year (October–September) streamflow for the Aksu River, which is an important river at the edge of the Taklimakan Desert that drains into the Tarim Basin. The reconstruction dates back to 1692 and has an adjusted r2 of 0.61 (1957–2006). Based on frequency, intensity and duration of droughts and pluvial events, the lowest streamflows occurred in the 1920s. Since then streamflow has continuously increased, and was exceptionally rapidly after the 1960s, until today. The start and end of the 20th century to the present were the highest streamflow periods. The mid-20th century was the longest and driest period over the past 300 yr. The reconstructed streamflow series has a strong positive correlation with the North Atlantic Oscillation Index. Changes in mid-latitude circulation patterns influencing precipitation may have indirectly resulted in streamflow variations along the Aksu River over the past 300 yr. The rapid increase and the exceptional streamflows of the 1960s are likely linked with global warming and mid-latitude atmospheric circulation changes.

We examined how external stakeholder pressure and ethical leadership independently and interactively influence the implementation of corporate social responsibility. Based on data collected from 292 employees from 53 companies (Study 1) and from 224 middle-level managers from 40 companies (Study 2) in mainland China, we found that both ethical leadership and external stakeholder pressure have significant and positive impacts on corporate social responsibility implementation and the positive effect of external stakeholder pressure on corporate social responsibility weakens under a higher level of ethical leadership and strengthens under a low level of ethical leadership. The theoretical and practical implications of these findings are discussed.

Spermatogonial stem cells (SSCs) have the ability to self-renew and offer a pathway for genetic engineering of the male germ line. Cryopreservation of SSCs has potential value for the treatment of male infertility, spermatogonial transplantation, and so on. In order to investigate the cryopreservation effects of different cryoprotectants on murine SSCs, 0.2 M of low-density lipoproteins (LDL), trehalose and soybean lecithin were added to the cryoprotective medium, respectively, and the murine SSCs were frozen at −80°C or −196°C. The results indicated that the optimal recovery rates of murine SSCs in the cryoprotective medium supplemented with LDL, trehalose and soybean lecithin were 92.53, 76.35 and 75.48% at −80°C, respectively. Compared with freezing at −196°C, the optimum temperature for improvement of recovery rates of frozen murine SSCs, cryopreservation in three different cryoprotectants at −80°C, were 17.11, 6.68 and 10.44% respectively. The recovery rates of murine SSCs in the cryoprotective medium supplemented with 0.2 M LDL were significantly higher than that of other cryoprotectants (P < 0.05). Moreover, the recovery rates were demonstrated to be greater at −80°C compared with at −196°C (P < 0.05). In conclusion, 0.2 M of LDL could significantly protect murine SSCs at −80°C. In the freezing–thawing process, LDL is responsible for the cryopreservation of murine SSCs because it can form a protective film at the surface of membranes. However, more research is needed to evaluate and understand the precise role of LDL during the freezing–thawing of SSCs.

Let α∈(0,1) be an irrational, and [0;a1,a2,…] the continued fraction expansion of α. Let Hα,V be the one-dimensional Schrödinger operator with Sturmian potential of frequency α. Suppose the potential strength V >20 and the sequence (ai)i≥1 is bounded. We proceed by developing some new ideas on dimensional theory of Cookie-cutter sets. We prove that the spectral generating bands satisfy the principles of bounded variation and bounded covariation, and then we show that there exists a Gibbs-like measure on the spectrum σ(Hα,V). As an application, we prove that where s* and s* are the lower and upper pre-dimensions. Moreover, if (an)n≥1 is ultimately periodic, then s* =s*.

Cryopreservation can cause cumulus cell damage around the immature oocytes, which may result in poor subsequent development. To evaluate the effect of the meiosis stage on the cumulus cell cryoinjury and determine the suitable stage for cryopreservation in immature oocytes, mouse oocytes at germinal vesicle (GV) and germinal vesicle breakdown (GVBD) stages were vitrified using open pulled straw (OPS) method. Cumulus cells damage was scored immediately after thawing by double-fluorescent staining. The survival rate of the oocytes was evaluated and the subsequent development of oocytes was assessed through in vitro culture (IVC) and in vitro fertilization (IVF) separately. After vitrification, a higher proportion of cumulus cells of GV oocytes were damaged than those of GVBD and untreated control groups. The survival rate of vitrified GVBD oocytes (94.1%) was significantly higher (p < 0.05) than that of GV oocytes (85.4%). Oocytes vitrified at GVBD stage (55.7%) showed similar cleavage rate compared to those at GV stage (49.2%), but significantly higher (p < 0.05) blastocyst rate (40.9% vs. 27.4%). These results demonstrate that oocytes at GVBD stage remain better cumulus membrane integrity and developmental ability during vitrification than those at GV stage, indicating they are more suitable for immature oocytes cryopreservation in mice.

Intergeneric transfer of plasmid vectors pSET152 and pHL212 from donor Escherichia coli ET12567/pUZ8002 and S17-1 to Streptomyces cinnamonensis was demonstrated and optimized. Assisted by this conjugation system, nsdA gene disruption was achieved through PCR-targeted gene replacement. One AprRKanS exconjugant BIB309 was then isolated and confirmed to be the nsdA null mutant. Compared with the starting strain, monensin production by the nsdA− mutant BIB309 increased 270% in vitro.

A real-time fluorescent polymerase chain reaction (PCR) assay was established to detect Streptococcus suis serotype 2. Primers and Taqman probe were designed according to cps2I (capsular polysaccharide 2I) gene using bio-software Primer Express2.0 and Oligo6.0. An 81 bp DNA fragment was amplified from S. suis serotype 2 genomic DNA, and the PCR product was cloned into pMD18-T vector and confirmed by DNA sequencing. The real-time fluorescent PCR amplification curve on a Lightcycler® showed that the method is accurate and specific for S. suis serotype 2 amplification, whereas reference bacteria S. suis, Escherichia coli, Salmonella sp., Staphylococcus aureus, Shigella sp., Listeria monocytogenes strains and a blank control were all negative. Tenfold serial dilutions of S. suis serotype 2 were used to measure the sensitivity of real-time fluorescent PCR: ten copies of bacteria could be detected in one PCR reaction and only 30 min were required for a single test. To examine the stability of the real-time fluorescent PCR, the positive control was detected at two different times. The threshold cycle (Ct) values showed no statistical differences (P>0.05). Thus, this method was stable and repeatable. These results indicate that this real-time fluorescent PCR technique could be applied for epidemic supervision in entry–exit inspection and quarantine.