Carbapenem-resistant Gram-negative bacteria (CR-GNB) in ICUs: resistance genes, therapeutics, and prevention – a comprehensive review

Intensive care units (ICUs) are specialized environments dedicated to the management of critically ill patients, who are particularly susceptible to drug-resistant bacteria. Among these, carbapenem-resistant Gram-negative bacteria (CR-GNB) pose a significant threat endangering the lives of ICU patients. Carbapenemase production is a key resistance mechanism in CR-GNB, with the transfer of resistance genes contributing to the extensive emergence of antimicrobial resistance (AMR). CR-GNB infections are widespread in ICUs, highlighting an urgent need for prevention and control measures to reduce mortality rates associated with CR-GNB transmission or infection. This review provides an overview of key aspects surrounding CR-GNB within ICUs. We examine the mechanisms of bacterial drug resistance, the resistance genes that frequently occur with CR-GNB infections in ICU, and the therapeutic options against carbapenemase genotypes. Additionally, we highlight crucial preventive measures to impede the transmission and spread of CR-GNB within ICUs, along with reviewing the advances made in the field of clinical predictive modeling research, which hold excellent potential for practical application

Structure-Mediated Excitation of Air Plasma and Silicon Plasma Expansion in Femtosecond Laser Pulses Ablation

Femtosecond laser-induced surface structures upon multiple pulses irradiation are strongly correlated with the pulse number,which in turn significantly affects successive laser-material interactions. By recording the dynamics of femtosecond laser ablation of silicon using time-resolved shadowgraphy, here we present direct visualization of the excitation of air plasma induced by the reflected laser during the second pulse irradiation.The interaction of the air plasma and silicon plasma is found to enhance the shockwave expansion induced by silicon ablation in the longitudinal direction, showing anisotropic expansion dynamics in different directions. We further demonstrate the vanishing of air plasma as the pulse number increases because of the generation of a rough surface without light focusing ability. In the scenario, the interaction of air plasma and silicon plasma disappears; the expansion of the silicon plasma and shockwave restores its original characteristic that is dominated by the laser-material coupling.The results show that the excitation of air plasma and the laser-material coupling involved in laser-induced plasma and shockwave expansion are structure mediated and dependent on the pulse number, which is of fundamental importance for deep insight into the nature of laser-material interactions during multiple pulses ablation

The impact of gene polymorphism and hepatic insufficiency on voriconazole dose adjustment in invasive fungal infection individuals

Voriconazole (VRZ) is a broad-spectrum antifungal medication widely used to treat invasive fungal infections (IFI). The administration dosage and blood concentration of VRZ are influenced by various factors, posing challenges for standardization and individualization of dose adjustments. On the one hand, VRZ is primarily metabolized by the liver, predominantly mediated by the cytochrome P450 (CYP) 2C19 enzyme. The genetic polymorphism of CYP2C19 significantly impacts the blood concentration of VRZ, particularly the trough concentration (Ctrough), thereby influencing the drug’s efficacy and potentially causing adverse drug reactions (ADRs). Recent research has demonstrated that pharmacogenomics-based VRZ dose adjustments offer more accurate and individualized treatment strategies for individuals with hepatic insufficiency, with the possibility to enhance therapeutic outcomes and reduce ADRs. On the other hand, the security, pharmacokinetics, and dosing of VRZ in individuals with hepatic insufficiency remain unclear, making it challenging to attain optimal Ctrough in individuals with both hepatic insufficiency and IFI, resulting in suboptimal drug efficacy and severe ADRs. Therefore, when using VRZ to treat IFI, drug dosage adjustment based on individuals’ genotypes and hepatic function is necessary. This review summarizes the research progress on the impact of genetic polymorphisms and hepatic insufficiency on VRZ dosage in IFI individuals, compares current international guidelines, elucidates the current application status of VRZ in individuals with hepatic insufficiency, and discusses the influence of CYP2C19, CYP3A4, CYP2C9, and ABCB1 genetic polymorphisms on VRZ dose adjustments and Ctrough at the pharmacogenomic level. Additionally, a comprehensive summary and analysis of existing studies’ recommendations on VRZ dose adjustments based on CYP2C19 genetic polymorphisms and hepatic insufficiency are provided, offering a more comprehensive reference for dose selection and adjustments of VRZ in this patient population

Structure-Mediated Excitation of Air Plasma and Silicon Plasma Expansion in Femtosecond Laser Pulses Ablation

Femtosecond laser-induced surface structures upon multiple pulses irradiation are strongly correlated with the pulse number, which in turn significantly affects successive laser-material interactions. By recording the dynamics of femtosecond laser ablation of silicon using time-resolved shadowgraphy, here we present direct visualization of the excitation of air plasma induced by the reflected laser during the second pulse irradiation. The interaction of the air plasma and silicon plasma is found to enhance the shockwave expansion induced by silicon ablation in the longitudinal direction, showing anisotropic expansion dynamics in different directions. We further demonstrate the vanishing of air plasma as the pulse number increases because of the generation of a rough surface without light focusing ability. In the scenario, the interaction of air plasma and silicon plasma disappears; the expansion of the silicon plasma and shockwave restores its original characteristic that is dominated by the laser-material coupling. The results show that the excitation of air plasma and the laser-material coupling involved in laser-induced plasma and shockwave expansion are structure mediated and dependent on the pulse number, which is of fundamental importance for deep insight into the nature of laser-material interactions during multiple pulses ablation

An efficient and provable secure revocable identity-based encryption scheme.

Revocation functionality is necessary and crucial to identity-based cryptosystems. Revocable identity-based encryption (RIBE) has attracted a lot of attention in recent years, many RIBE schemes have been proposed in the literature but shown to be either insecure or inefficient. In this paper, we propose a new scalable RIBE scheme with decryption key exposure resilience by combining Lewko and Waters' identity-based encryption scheme and complete subtree method, and prove our RIBE scheme to be semantically secure using dual system encryption methodology. Compared to existing scalable and semantically secure RIBE schemes, our proposed RIBE scheme is more efficient in term of ciphertext size, public parameters size and decryption cost at price of a little looser security reduction. To the best of our knowledge, this is the first construction of scalable and semantically secure RIBE scheme with constant size public system parameters

An efficient and provable secure revocable identity-based encryption scheme.

Revocation functionality is necessary and crucial to identity-based cryptosystems. Revocable identity-based encryption (RIBE) has attracted a lot of attention in recent years, many RIBE schemes have been proposed in the literature but shown to be either insecure or inefficient. In this paper, we propose a new scalable RIBE scheme with decryption key exposure resilience by combining Lewko and Waters' identity-based encryption scheme and complete subtree method, and prove our RIBE scheme to be semantically secure using dual system encryption methodology. Compared to existing scalable and semantically secure RIBE schemes, our proposed RIBE scheme is more efficient in term of ciphertext size, public parameters size and decryption cost at price of a little looser security reduction. To the best of our knowledge, this is the first construction of scalable and semantically secure RIBE scheme with constant size public system parameters

The Effect Evaluation of China’s Energy-Consuming Right Trading Policy: Empirical Analysis Based on PSM-DID

Identifying the policy effect of Energy-Consuming Right Trading (ECRT), clarifying its mechanism of energy conservation and consumption reduction, is beneficial to realize the win–win situation of economic growth and emission reduction in China. This study first builds a Propensity Score Matching–Difference-in-Differences (PSM-DID) model and empirically tests the impact of Energy-Consuming Right Trading policy on energy intensity in pilot areas based on inter-provincial panel data from 2010 to 2019. Then the policy mechanism was analyzed by further regression, and the spatial effects of the policy were explored by the Spatial Difference-in-Differences (SDID) model. The results show that: (1) The policy can reduce energy intensity by 6.4% to 10.2% in the pilot area. (2) The policy mainly achieves energy consumption reduction by optimizing the industrial structure and promoting scientific and technological input, while the resource tax intensity and the proportion of coal consumption also have synergistic and hindering effects on the policy. (3) There is a significant spatial spillover effect of the policy; it can reduce the energy intensity of the adjacent areas of the pilot by 5.3% and the areas with a high economic association with the pilot by 12%. The conclusion is that China’s Energy-Consuming Right Trading policy can effectively control energy consumption, and the policy shows an excellent positive external effect, worth nationwide implementation. Finally, some policy suggestions are put forward according to the results of the empirical analysis