Search

Although antimicrobial resistance poses a great challenge to clinicians in China, there are limited antimicrobial resistance data on Gram-negative bacteria nationwide. We investigated the phenotypic characteristics of carbapenem-resistant Escherichia coli (CREC) and Klebsiella pneumoniae (CRKP) as well as extensively drug-resistant strains of Pseudomonas aeruginosa (XDRPA) and Acinetobacter baumannii (XDRAB) isolated from blood cultures in China. Data were collected on 24113 isolates from the China surveillance of antimicrobial resistance program in 2013, which comprised 208 hospitals located in all seven administrative regions of China. Minimum inhibitory concentrations (MICs) for common antimicrobials were determined by commercial automated systems available at local hospitals, and associations with geographic and clinical distributions was further studied. The overall prevalence of CREC, CRKP, XDRAB and XDRPA strains was 1.0, 5.5, 13.7 and 4.2%, respectively. Except for CREC, which did not differ greatly by region, the prevalence of the remaining three strains varied significantly across regions. The highest prevalence of CRKP (10.6%) and XDRAB (13.1%) were found in the pediatric group, and higher prevalence of all four target strains was found in the intensive care unit. For imipenem, 55.8% of CREC and 22.9% of CRKP strains had MICs of ≤4 μg/mL, while 97.4% XDRAB and 84% XDRPA isolates had MICs of ≥16 μg/mL. All CREC, CRKP and 81.2% of XDRAB strains were susceptible to tigecycline, with MIC90 values of 0.5, 2 and 4 μg/mL, respectively. In conclusion, a high prevalence of CRKP and XDRAB has emerged in China, especially in children and in the intensive care unit., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In this randomised double-blind study, patients >or=40 years old with COPD, a smoking history of >or=10 pack-years, a pre-bronchodilator FEV(1) of

Background: Several studies have demonstrated the inhibitory effect of propofol on diaphragmatic contractility in laboratory animals, but there have been few studies in humans. We have investigated the effect of a single bolus injection of propofol on twitch diaphragmatic pressure (TwPdi) evoked by cervical supramaximal magnetic stimulation, and its impact on diaphragmatic contractility., Methods: In 16 patients scheduled for elective operation, TwPdi was evoked bilaterally at the cervical phrenic nerves with supramaximal magnetic stimulations using a 140 mm diameter magnetic coil. Changes of TwPdi were monitored dynamically before and during general anaesthesia induced by single bolus of propofol 2 mg kg (-1). During the study, all patients breathed 100% oxygen by a face mask, maintaining Sp(O(2)) > or = 99% and PE'(CO(2)) 4.6-5.2 kPa., Results: TwPdi declined after administration of propofol with gradual recovery. Compared with baseline [20.6 (6.0) cm H(2)O], TwPdi decreased by 23.3% (P<0.001) to [15.8 (6.4) cm H(2)O]. When the patients regained awareness, TwPdi returned to [19.1 (6.1) cm H(2)O], close to baseline (P=0.063). The time from starting the propofol infusion to the lowest TwPdi was [240 (86) s]. Total time course of stimulation lasted [363 (89) s]., Conclusions: A single bolus propofol depressed TwPdi evoked by cervical magnetic stimulation, demonstrating inhibitory effects of propofol on diaphragmatic contractility in patients during general anaesthesia.

Background: An epidemic of severe acute respiratory syndrome (SARS) has been associated with an outbreak of atypical pneumonia originating in Guangdong Province, People's Republic of China. We aimed to identify the causative agent in the Guangdong outbreak and describe the emergence and spread of the disease within the province., Methods: We analysed epidemiological information and collected serum and nasopharyngeal aspirates from patients with SARS in Guangdong in mid-February, 2003. We did virus isolation, serological tests, and molecular assays to identify the causative agent., Findings: SARS had been circulating in other cities of Guangdong Province for about 2 months before causing a major outbreak in Guangzhou, the province's capital. A novel coronavirus, SARS coronavirus (CoV), was isolated from specimens from three patients with SARS. Viral antigens were also directly detected in nasopharyngeal aspirates from these patients. 48 of 55 (87%) patients had antibodies to SARS CoV in their convalescent sera. Genetic analysis showed that the SARS CoV isolates from Guangzhou shared the same origin with those in other countries, and had a phylogenetic pathway that matched the spread of SARS to the other parts of the world., Interpretation: SARS CoV is the infectious agent responsible for the epidemic outbreak of SARS in Guangdong. The virus isolated from patients in Guangdong is the prototype of the SARS CoV in other regions and countries.

To determine the possibility that asymptomatic bronchial hyperresponsiveness (BHR) develops into symptomatic asthma, a two-year follow-up study was conducted in 81 students (48 male, 33 female; 11 to 17 years) who were found to have BHR in a 3,067 population survey (BHR group). Eighty-eight age-matched students (48 male, 40 female) with normal bronchial responsiveness served as control subjects. Daily symptom cards were recorded. Peak expiratory flow rate was measured for 24 h when symptoms occurred. Histamine inhalation tests were performed at the beginning of the study and at the end of the first and the second year. In the BHR group, 58 students remained bronchial hyperresponsive at the end of follow-up. Nine of 31 students with initially diagnosed bronchial asthma had their symptoms relieved entirely, but ten asymptomatic students developed asthma. The incidence of newly diagnosed asthma (12.5 percent in the BHR group or 20 percent in the asymptomatic BHR group) and the total percentage of diagnosed asthma (39.5 percent) in the BHR group were significantly higher than those (2.27 percent, 2.27 percent) in the control group. FVC and FEV1 showed no significant difference between two groups. PD20 FEV1 values in newly diagnosed asthmatics were significantly lower than those in asymptomatic students both at the beginning (3.05 +/- 1.56 mumol vs 6.14 +/- 1.60 mumol, p < 0.05) or the end (3.47 +/- 1.73 mumol vs 6.55 +/- 1.51 mumol, p < 0.05). The percentage of early respiratory illness was significantly higher in those with newly diagnosed asthma (80 percent) than in asymptomatic students (22.3 percent), but atopic index and the percentage of parental asthma showed no difference between two groups. In nine asthmatics whose symptoms were relieved entirely in the two-year follow-up, PD20 FEV1 was undetectable within the cumulative dose of 7.8 mumol of histamine in three students and rose from 4.58 +/- 1.85 mumol to 7.62 +/- 1.02 mumol in the remaining six. The higher the BHR, the more likely the students developed asthma. About 45 percent of asymptomatic students with PD20 < or = 3.2 mumol developed asthma in the following two years and 80 percent of them had a history of early respiratory illness, suggesting that they may have subclinical or potential asthma.

Arterial oxygenation was measured in patients being ventilated artificially for respiratory failure, initially at the FIO2 that had been selected clinically to achieve PaO2 at least normal, and then at each of two or three progressively increased FIO2 values up to about 0.9. Impairment of oxygen transfer was assessed by the difference between calculated pulmonary end-capillary and arterial oxygen content (Cc'O2-CaO2). Reasons are presented to support the assumption that this value indicates the degree of venous admixture. In patients with severely impaired gas exchange ((Cc'O2-CaO2) greater than 1 ml dl-1), the first increase in inspired oxygen decreased the impairment: less severely impaired lungs showed no change. The observations are consistent with the ventilation/perfusion mismatch hypothesis and do not show that increased oxygen impairs pulmonary oxygenating efficiency.