Molecular Epidemiology of Multi-Drug Resistant Acinetobacter baumannii Isolated in Shandong, China

Acinetobacter baumannii is an emerging nosocomial pathogen prevalent in hospitals worldwide. In order to understand the molecular epidemiology of multi-drug resistant (MDR) A. baumannii, we investigated the genotypes of A. baumannii isolated from ten hospitals in Shandong, China, from August 2013 to December 2013, by pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Antimicrobial resistance genes were analyzed by PCR and DNA sequencing. By PFGE analysis, we discovered 11 PFGE types in these ten hospitals. By MLST, we assigned these isolates to 12 sequence types (STs), 10 of which belong to the cloning complex CC92, including the prevalent ST369, ST208, ST195, and ST368. Two new STs, namely ST794 and ST809, were detected only in one hospital. All isolates of the MDR A. baumannii were resistant to carbapenem, except 2 isolates, which did not express the blaOXA-23 carbapenemase gene, indicating blaOXA-23 is the major player for carbapenem resistance. We also discovered armA is likely to be responsible for amikacin resistance, and may play a role in gentamicin and tobramycin resistance. aac(3)-I is another gene responsible for gentamicin and tobramycin resistance. In summary, we discovered that the majority of the isolates in Shandong, China, were the STs belonging to the CC92. Besides, two new STs were detected in one hospital. These new STs should be further investigated for prevention of outbreaks caused by A. baumannii

Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial

Background: Previous cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes. Methods: We conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized educational materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was all-cause mortality within 28 days of enrollment. Results: Forty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference − 0.40 [95% CI − 0.71 to − 0.09]; P = 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI 0.44 to 1.67]; P = 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference − 1.6% [95% CI − 4.3% to 1.2%]; P = 0.42) between groups. Conclusions: In this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness. Trial registration: ISRCTN, ISRCTN12233792. Registered November 20th, 2017

Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial.

BackgroundPrevious cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes.MethodsWe conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized educational materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was all-cause mortality within 28 days of enrollment.ResultsForty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference - 0.40 [95% CI - 0.71 to - 0.09]; P = 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI 0.44 to 1.67]; P = 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference - 1.6% [95% CI - 4.3% to 1.2%]; P = 0.42) between groups.ConclusionsIn this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness.Trial registrationISRCTN, ISRCTN12233792 . Registered November 20th, 2017

Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial (vol 26, 46, 2022)

BackgroundPrevious cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes.MethodsWe conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized educational materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was all-cause mortality within 28 days of enrollment.ResultsForty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference - 0.40 [95% CI - 0.71 to - 0.09]; P = 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI 0.44 to 1.67]; P = 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference - 1.6% [95% CI - 4.3% to 1.2%]; P = 0.42) between groups.ConclusionsIn this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness.Trial registrationISRCTN, ISRCTN12233792 . Registered November 20th, 2017

Computational Analysis of Sandwich Panels with Graded Foam Cores Subjected to Combined Blast and Fragment Impact Loading

This study aimed to evaluate the performance of sandwich panels with graded foam cores of layered densities against combined blast and fragment impact loading, and to ascertain the optimal gradient of core configuration that would maximize the performance of sandwich panels against combined loading. First, based on a recently developed composite projectile, impact tests of the sandwich panels against simulated combined loading were conducted to provide a benchmark for the computational model. Second, a computational model, based on three-dimensional finite element simulation, was constructed and verified by means of a comparison of the numerically calculated and experimentally measured peak deflections of the back facesheet and the residual velocity of the penetrated fragment. Third, the structural response and energy absorption characteristics were examined, based on numerical simulations. Finally, the optimal gradient of core configuration was explored and numerically examined. The results indicated that the sandwich panel responded in a combined manner involving global deflection, local perforation and perforation hole enlargement. As the impact velocity increased, both the peak deflection of the back facesheet and the residual velocity of the penetrated fragment increased. The front facesheet was found to be the most important sandwich component in consuming the kinetic energy of the combined loading. Thus, the compaction of the foam core would be facilitated by placing the low-density foam at the front side. This would further provide a larger deflecting space for the front facesheet, thus reducing the deflection of the back facesheet. The gradient of core configuration was found to have limited influence on the anti-perforation ability of the sandwich panel. Parametric study indicated that the optimal gradient of foam core configuration was not sensitive to time delay between blast loading and fragment impact loading, but was sensitive to the asymmetrical facesheet of the sandwich panel

New understandings of the seismic modes of high productivity wells in the Sinian Dengying Fm gas reservoirs in the Gaoshiti area, Sichuan Basin

The Sinian Dengying Fm in the Sichuan Basin is a set of fractured-vuggy reservoirs mainly dominated by sedimentation and karstification, and characterized by small fractures and vugs, complex stratigraphy and lithology, and strong vertical and lateral reservoir heterogeneity. As a result, the drilling rates are lower and single-well gas productivity varies greatly there. And the reservoir identification results based on seismic data in this area are ambiguous. In view of this, the Deng 4 Member in the Gaoshiti buried structure on the southern flank of the Leshan–Longnüsi palaeohigh was precisely divided in stratigraphy. Then, the types of reservoir assemblages were determined based on gas well logging and test data, and the seismic response characteristics of typical wells with different types of reservoir assemblages and the seismic modes of high productivity wells were studied by using high-resolution seismic data. It is indicated that the Deng 4 Member in this area is divided into three types of reservoir assemblages, which correspond to three seismic modes. Seismic mode I: It presents the seismic response characteristics of “wide wave troughs + double highlights” or “wide wave troughs + complex waves”, indicating that fractures and vugs are developed. It is the preferred seismic mode of high productivity wells in the stage of development. In this mode, the technology of highly deviated wells or horizontal wells can be implemented. Seismic mode II: It presents the seismic response characteristics of “wide wave troughs”, indicating that fractures and vugs are relatively developed. It is the mode of moderate productivity wells. In this mode, the technology of highly deviated wells can be implemented. Seismic mode III: It presents the seismic response characteristics of “wide wave troughs + highlights”, indicating that fractures and vugs are underdeveloped. It is mode of low productivity wells, in which the technology of horizontal wells can be implemented. The new understandings on seismic modes were applied on site. It is shown that the reservoir drilling rate is over 60% and the average gas production rate during the production test of 8 wells is up to 75.34 × 104 m3/d. It is concluded that the seismic mode of high productivity wells based on seismic facies, fracture and vug prediction and integrated target design provides a support for the well arrangement and drilling trajectory adjustment in natural gas exploration and development in the Gaoshiti area and good results have been achieved. Keywords: Sichuan Basin, Gaoshiti area, Sinian, Dengying Formation, Karst, Fractured-vuggy reservoir, Seismic response, Seismic mode of high productivity well, Fracture and vug predictio

Genome-Wide Identification of <i>MDH</i> Family Genes and Their Association with Salt Tolerance in Rice

Malate dehydrogenase (MDH) is widely present in nature and regulates plant growth and development, as well as playing essential roles, especially in abiotic stress responses. Nevertheless, there is no comprehensive knowledge to date on MDH family members in rice. In this study, a total of 12 MDH members in rice were identified through genome-wide analysis and divided into three groups on the basis of their phylogenetic relationship and protein-conserved motifs. Evolutionary analysis showed that MDH proteins from rice, maize and wheat shared a close phylogenetic relationship, and the MDH family was conserved in the long-term process of domestication. We identified two segmental duplication events involving four genes, which could be the major force driving the expansion of the OsMDH family. The expression profile, cis-regulatory elements and qRT-PCR results of these genes revealed that a few OsMDH showed high tissue specificity, almost all of which had stress response elements in the promoter region, and ten MDH members were significantly induced by salt stress. Through gene-based association analysis, we found a significant correlation between salt tolerance at the seedling stage and the genetic variation of OsMDH8.1 and OsMDH12.1. Additionally, we found that the polymorphism in the promoter region of OsMDH8.1 might be related to the salt tolerance of rice. This study aimed to provide valuable information on the functional study of the rice MDH gene family related to salt stress response and revealed that OsMDH8.1 might be an important gene for the cultivar improvement of salt tolerance in rice

Combinatorial development of antibacterial FeCoCr-Ag medium entropy alloy

Antibacterial activity and mechanical properties of FeCoCr-Ag medium entropy alloys were studied via combinatorial fabrication paired with high-throughput characterizations. It was found that the antibacterial activity and mechanical properties exhibit non-linear dependence on the content of Ag addition. Within the studied alloys, (FeCoCr) _80 Ag _20 possesses an optimized combination of different properties for potential applications as antibacterial coating materials. The underlying mechanism is ascribed to the formation of a dual-phase structure that leads to competition between the role of Ag phase and FeCoCr phase at different Ag content. The results not only demonstrate the power and effectiveness of combinatorial methods in multi-parameter optimization but also indicate the potential of high entropy alloys as antibacterial materials

Breakthrough and significance of technology on internal multiple recognition and suppression: A case study of Ordovician Dengying Formation in Central Sichuan Basin, SW China

Aimed at the serious mismatch between the synthetic seismogram and the real data of the Sinian Dengying Formation and the Lower Cambrian Qiongzhusi Formation in the GS1 well area, Sichuan Basin, four aspects of internal multiples identification and suppression were studied. Firstly, a forward modeling method of internal multiple based on reflectivity method was developed. Through eight means such as post-stack and pre-stack forward modeling of internal multiple, and combined with VSP data, it was demonstrated that well-seismic mismatching in this area is mainly caused by the internal multiples. Secondly, the simulation results of internal multiple forward modeling using the stripping method combined with the internal multiple periodicity analysis showed that four groups of overburden layers with velocity inversion were the main sources of the internal multiples. Thirdly, by identifying internal multiples accurately and using suppression technology based on pattern recognition, an effective and replicable suppression scheme suitable for these formations was established, overcoming the difficulty of the small speed difference between internal multiple and primary reflection wave which makes the current methods ineffective. Fourthly, an evaluation index of internal multiple intensity was proposed, and the internal multiple intensity distribution diagram of the fourth member of Dengying Formation (Deng-4 Member) in Gaoshiti-Moxi area was compiled. This scheme greatly improved the well-seismic match, and the strata sedimentary features are clearer on the new seismic profiles with higher lateral resolution, with which smaller faults and geological anomalies can be identified and a series of the bead reflections in the Dengying Formation are first discovered. The coincidence rate of reservoir prediction based on seismic waveform classification was increased from 60% to 90%, and that of hydrocarbon detection based on dual phase medium theory was increased from 70% to 100%. Key words: internal multiple, reflectivity method forward modeling, well-seismic match, velocity inversion, seismic waveform classification, hydrocarbon detection, Sichuan Basin, Sinian Dengying Formatio