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Alternative antimicrobial therapies are urgently needed for a variety of multidrug-resistant bacterial pathogens. Faropenem is an orally available β-lactam in the class of carbapenem antibiotics. Thus far, little information is available on faropenem susceptibility of multidrug-resistant clinical isolates from China. Therefore, in the current study 141 contemporary clinical isolates, including methicillin-resistant Staphylococcus aureus (MRSA: n = 18), coagulase-negative staphylococci (CNS: n = 16), Enterococcus faecalis (n = 14), Enterococcus faecium (n = 7), Pseudomonas aeruginosa (n = 25), Klebsiella pneumoniae (n = 21), Escherichia coli (n = 20), and Acinetobacter baumannii (n = 20), were collected between March 2018 and March 2019 and tested for susceptibility to faropenem and other antimicrobials using the broth microdilution method. All E. faecium, P. aeruginosa, and A. baumannii isolates were fully resistant to faropenem. However, most of the MRSA, CNS, E. faecalis, K. pneumonia, and E. coli isolates appeared to be susceptible to faropenem, with minimal inhibitory concentration90 values of 4 mg/L, 2 mg/L, 2 mg/L, 4 mg/L, and 2 mg/L, respectively. Therefore, faropenem could be considered as alternative therapy for future treatment of multidrug-resistant MRSA, CNS, E. faecalis, K. pneumonia, and E. coli infections in China.

Objective: The novel coronavirus pneumonia (COVID-19) has spread rapidly across the globe with the movement of people. How to diagnose COVID-19 quickly and accurately is a concern for all. We retrospectively assessed the clinical characteristics of patients with COVID-19 detected by outpatient screening in areas outside Wuhan, China, to guide early screening outside the epidemic area, to isolate and treat COVID-19-positive patients, and to control the spread of this virus in the region.Results: Among the 213 patients treated in the fever clinic of our hospital, 41 tested positive for novel coronavirus (2019-nCoV) and 172 were negative. Among the positive patients, 13 (31.7%) of the patients had been to Wuhan, while 28 (68.3%) had not been to Wuhan. There were 4 cases of clustering occurrence. The main symptoms exhibited by COVID-19-positive patients were fever (87.8%), cough (68.3%), and expectoration (34.1%). The C-reactive protein (CRP) levels were increased in 35 (85.3%) positive patients; the hydroxybutyrate dehydrogenase in the myocardial zymogram was increased in 22 positive patients (53.6%) and 38 negative patients (22.1%); computed tomography (CT) findings revealed lung lesions in all 41 positive patients (100%).Conclusion: We classified the patient population and analyzed the data to understand the early clinical performance of COVID-19. Our research illustrate that screening for COVID-19 outside Wuhan should focus on early symptoms such as fever and cough, in combination with lung CT findings, epidemiological history, and sputum pathogen detection to determine whether patients need further isolation.

Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients.We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death.The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission.During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.).

With the continuous promotion of medical informatization, electronic medical data is rapidly increasing. And in the field of natural language processing, it has been increasingly used in conjunction with text processing technology to assist doctors in diagnosis. To solve the problem of large amount of redundancy, missing semantics, and ambiguity in the text part of the electronic medical data, this paper combines the word vector method and deep learning theory. The vectorization of medical text data words is expressed in a fixed-length matrix, Then, it combines LSTM model with Yoon model, Finally, the integrative learning method is used to obtain a comprehensive learning model, and this has achieved good results in the text classification of electronic medical data.

Automatic detection of electrocardiogram (ECG) plays an important role in reducing pressure of nursing patients with heart disease. There have been many studies about ECG classification,which mostly based on machine learning, such as neural networks, extreme learning machine (ELM), and have reached a high accuracy. But it remains to be improved when applied in practice. In this paper, we propose a more practical method, namely the weighted ELM algorithm,which has better time performance and better generalization capability than traditional machine learning method. In particular,classification models trained by this method have better decision-boundary when faced with the imbalance ECG samples.

The computer-aid diagnosis of liver disease plays an important role in timely detection and treatment of liver. Convolutional Neural Network (CNN) get problems of low accuracy. This paper introduces a method based on improved CNN and Random Forest(RF), which has a higher accuracy than traditional CNN.

With rapid development of medical information, more and more attention has been paid to the intelligent diagnosis based on electronic medical records. The results of intelligent diagnosis can provide doctors with advice in the course of diagnosis and treatment, and avoid unnecessary mistakes. In the field of intelligent text aided diagnosis, how to extract and express a large amount of text information in the medical record plays a key role. The final result of classification and prediction is based on the characterization of text information using some mathematical models. In the past, we used single feature set to get the final results, which could not achieve our expect, and the results affected the reliability of intelligent diagnosis. This paper puts forward a kind of combined text representation method based on weighted LDA and word vector model, we get the combined feature set by this way and use it to classify liver disease. By combining the weighted LDA and the word vector model, we can make full use of the potential text information of the electronic medical records, improve the accuracy of classification prediction, and increase the reliability of intelligent diagnosis.

Background & Aims Even though various experimental therapeutic approaches for chronic hepatitis B infection have been reported, few of them have been verified by clinical trials. We have developed an antigen-antibody (HBsAg-HBIG) immunogenic complex therapeutic vaccine candidate with alum as adjuvant (YIC), aimed at breaking immune tolerance to HBV by modulating viral antigen processing and presentation. A double-blind, placebo-controlled, phase II B clinical trial of YIC has been reported previously, and herein we present the results of the phase III clinical trial of 450 patients. Methods Twelve doses of either YIC or alum alone as placebo were administered randomly to 450 CHB patients and they were followed for 24weeks after the completion of immunization. The primary end point was HBeAg seroconversion, and the secondary end points were decrease in viral load, improvement of liver function, and histology. Results In contrast to the previous phase II B trial using six doses of YIC and alum as placebo, six more injections of YIC or alum resulted in a decrease of the HBeAg seroconversion rate from 21.8% to 14.0% in the YIC group, but an increase from 9% to 21.9% in the alum group. Decrease in serum HBV DNA and normalization of liver function were similar in both groups ( p >0.05). Conclusions Overstimulation with YIC did not increase but decreased its efficacy due to immune fatigue in hosts. An appropriate immunization protocol should be explored and is crucial for therapeutic vaccination. Multiple injections of alum alone could have stimulated potent inflammatory and innate immune responses contributing to its therapeutic efficacy, and needs further investigation.

Acute on chronic liver failure (AoCLF) is associated with a high mortality rate. Plasma exchange (PE) may be useful to bridge patients with AoCLF to liver transplantation or to regenerate their own livers. The aim of this study was to assess the effects of PE on the circulating concentrations of cytokines in patients with AoCLF.One hundred forty-nine patients with AoCLF in 2 groups (PE plus routine-care, n=62; and routine-care, n=87) were enrolled in our study. Fifteen healthy donors were used as the control group. Cytokine levels such as interferon-γ (IFN-γ), interleukin-10 (IL-10), interleukin-4 (IL-4), interleukin-2 (IL-2), and tumor necrosis factor- α (TNF-α) were detected on admission and on days 7, 14, 21, and 30 during hospitalization.All the detected cytokine values (IFN-γ, IL-10, IL-4, IL-2, and TNF-α) in the patient groups were higher compared with those in the healthy controls (P0.001). PE was effective to decrease the serum concentration of cytokines: TNF-α dropped from (3.46±1.23) pg/mL to (1.64±0.66) pg/mL (P0.01), IL-10 from (6.2±2.1) pg/mL to (3.5±1.1) pg/mL (P0.01), IL-2 from (7.5±4.7) pg/mL to (4.0±2.1) pg/mL (P0.01), IFN-γ from (27.5±15.8) pg/mL to (15.5±11.8) pg/mL (P0.01), and IL-4 from (86.7±31.3) pg/mL to (44.7±26.3) pg/mL (P0.01).Cytokines may be important in the pathogenesis of the AoCLF, and PE may represent a reliable hepatic support device for AoCLF.

To the Editor: Mycobacteria are commonly characterized by positive acid-fast staining. Most mycobacterial species belong to the nontuberculous mycobacteria (NTM), excluding species in the Mycobacterium tuberculosis complex and M. leprae. Both M. tuberculosis and NTM can induce pulmonary infection with similar symptoms and pulmonary radiographic findings (1). These similarities have led to difficulty in distinguishing these infections clinically. As in many developing countries, the acid-fast stain is the only bacteriologic basis for diagnosing tuberculosis (TB) in primary health care institutions in China, where facilities are limited for M. tuberculosis culture, strain identification, and drug resistance detection. Thus, NTM is easily misdiagnosed as M. tuberculosis, and multidrug-resistant (MDR) TB is unable to be accurately identified. Patients with misdiagnosed TB usually are treated with the standard anti-TB regimens recommended by the Chinese government (i.e., 2HRZE/4HR [2 months of isoniazid (INH), rifampin (RIF), pyrazinmid, and ethambutol, followed by 4 months of INH and RIF 1 time daily] and 2H3R3Z3E3/4H3R3 [2 months of INH, RIF, pyrazinamide, and ethambutol followed by 4 months of INH and RIF 3 times weekly]) (2), which often results in treatment failures. Misdiagnosis is a key hurdle for effective prevention and treatment of TB (3–5). To evaluate the effect of misdiagnosis on TB prevention, we determined the proportion of patients with MDR TB and NTM infection in primary health care institutions in Zhejiang Province, China. Our findings would be useful for improving TB prevention and treatment. During 2011–2012, sputum samples from 13,882 patients suspected of having TB in 8 counties in Zhejiang Province were used to culture mycobacteria. Each sample was seeded onto 2 pieces of Lowenstein-Jensen medium. A total of 1,410 samples grew mycobacteria confirmed as acid-fast bacilli by using Ziehl-Neelsen staining. The 1,410 samples were further identified by using the Mycobacteria Identification Array Kit (CapitalBio, Beijing, China). The kit contains 17 types of bacilli-specific 16S rRNA probes (i.e., M. tuberculosis complex, M. avium, M. intracellulare, M. gilvum, M. xenopi, M. smegmatis, M. aurum, M. terrae, M. gordonae, M. chelonae/abscessus, M. phlei, M. scrofulaceum, M. fortuitum, M. szulgai, M. ulcerans, M. marinum, and M. kansasii). With this method, M. tuberculosis and NTM can be distinguished, and the species of NTM can be identified (6–8). Of 1,410 positive strains, we identified 1,332 (94.5%) as M. tuberculosis and 78 (5.5%) as NTM. NTM strains were further identified as follows: M. intracellulare, 39 isolates; M. chelonae/abscessus, 12 isolates, M. kansasii, 13 isolates; M. avium, 3 isolates; M. fortuitum, 4 isolates; and M. scrofulaceum and M. szulgai, 1 isolate each. For 5 isolates, strain could not be classified. We detected drug resistance of 1,332 M. tuberculosis strains using a Tuberculosis Drug Resistance Detection Array Kit (CapitalBio) (9). The mutant points for RIF resistance were identified as follows: rpoB/C531G, C531T, CG531AC, A526C, A526G, A526T, C526A, C526G, C526T, T533C, A516G, A516T, G516T, T511C, T511G, C513A, A513T, and C522T (Table). Moreover, the kit contained 5 mutant points for INH resistance, including katG (G315A, G315C, G315T, and C315) and inhA (C-15T) (Table). Of 1,332 M. tuberculosis strains, we identified 1,115 (83.7%) RIF/INH-sensitive strains, 88 (6.6%) MDR TB strains, 83 (6.2%) INH-resistant strains, and 47 (3.5%) RIF-resistant strains. Of the 1,410 positive strains, 88 (6.2%) were MDR M. tuberculosis strains. Table Gene mutations of 214 drug-resistant tubercle bacilli, Zhejiang Province, China, 2011–2012 The epidemiology of TB in Zhejiang Province reflects the situation in China and some developing countries (10). The clinical diagnosis and treatment of >80% TB cases in China is performed mainly by primary health care institutions. However, almost 80% of these medical institutions do not have the capability to culture M. tuberculosis, detect drug resistance, and identify strains (7). Of 1,410 strains obtained from the patients in 8 counties of Zhejiang Province, 218 (15.5%) were MDR TB, INH resistant, and RIF resistant. These affected patients could not be effectively treated with the national standard regimens. Specifically, 88 patients with MDR TB would be at risk for extensively drug-resistant TB, and 83 patients with INH-resistant TB and 47 with RIF-resistant TB would be at risk for MDR TB. In addition, we identified 78 (5.5%) NTM strains. With the acid-fast stain, these illnesses would be misidentified as TB and, in most instances, also would be reported as treatment failures. Clearly, accurate diagnosis provided by the technologies used in this study for distinguishing NTM and M. tuberculosis, Mycobacterium strain identification, and drug-resistance detection would increase the cure rate and effectively prevent TB epidemics. For INH resistance, katG315 was a main mutant point of the M. tuberculosis strain; 140 (81.4%) of the 172 INH-resistant mutations were related to katG315. For RIF resistance, rpoB531 was a main mutant point; 84 (60.0%) of 140 RIF-resistant mutations were associated with rpoB531. Therefore, in future studies, more attention should be paid to the molecular epidemiology of katG315 and rpoB531. In conclusion, using the techniques for M. tuberculosis culture, Mycobacterium strain identification, and drug-resistance detection is necessary. It should be urgently pursued for accurate TB diagnosis in primary health care institutions in China to improve the prevention, treatment, and control of TB.

This study explored the effects of a classical Chinese medicine formula- Xiao-Chai-Hu Tang(XCHT) on the model mice with D-galactosamine -induced liver injury. Sixty male imprinting control region (ICR) mice were used in the present study, and they were separated randomly into 6 groups: a normal control group (Group A, n=10), a model control (Group B, n=10), a positive control (Group C, n=10), a low dose of XCHT group (Group D, n=10), a medium dose of XCHT group (Group E, n=10), and a high dose of XCHT group (Group F, n=10). ELISA was used to detect the IL-6 and TNF-α levels in the serum. Real-time PCR was performed to assess the expression of FasmRNA, Fas-LmRNA, Bcl-2mRNA of the liver tissues. Western blotting was used to detect the Bax protein expression of the liver tissues. The serum IL-6 and TNF-α levels of Group B were significantly higher than the other groups (P

BACKGROUND: There is limited data on the clinical outcome of patients with pandemic H1N1 (pH1N1) pneumonia who received oseltamivir treatment, especially when the treatment was administered more than 48 hours after symptom onset. METHODS: During the pandemic in 2009, a cohort of pH1N1 influenza pneumonia was built in China, and their clinical information was collected systematically, and analyzed with Cox models. RESULTS: 920 adults and 541 children with pneumonia who didn't receive corticosteroids were analyzed. In-hospital mortality was higher in adults who did not receive antiviral therapy (18.2%) than those with who received oseltamivir ≤ 2 days (2.9%), between 2-5 days (4.6%) and >5 days after illness onset (4.9%), p5 days, respectively. For males patients, aged ≥ 14 years and baseline PaO(2)/FiO(2)3.8 mg/kg/d) did not improve clinical outcome (mortality, higher dose 2.5% vs standard dose 2.8%, p>0.05). CONCLUSIONS: Antiviral therapy might reduce mortality of patients with pH1N1 pneumonia, even when initiated more than 48 hours after onset of illness. Greater protective effects might be in males, patients aged 14-60 years, and patients with PaO(2)/FiO(2)