Guidelines for the diagnosis,treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli

The dissemination of carbapenem-resistant Gram-negative bacilli (CRGNB) is a global public health issue. CRGNB isolates are usually extensively drug-resistant or pandrug-resistant, resulting in limited antimicrobial treatment options and high mortality. A multidisciplinary guideline development group covering clinical infectious diseases, clinical microbiology, clinical pharmacology, infection control, and guideline methodology experts jointly developed the present clinical practice guidelines based on best available scientific evidence to address the clinical issues regarding laboratory testing, antimicrobial therapy, and prevention of CRGNB infections. This guideline focuses on carbapenem-resistant Enterobacteriales (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Pseudomonas aeruginosa (CRPA). Sixteen clinical questions were proposed from the perspective of current clinical practice and translated into research questions using PICO (population, intervention, comparator, and outcomes) format to collect and synthesize relevant evidence to inform corresponding recommendations. The grading of recommendations, assessment, development and evaluation (GRADE) approach was used to evaluate the quality of evidence, benefit and risk profile of corresponding interventions and formulate recommendations or suggestions. Evidence extracted from systematic reviews and randomized controlled trials (RCTs) was considered preferentially for treatment-related clinical questions. Observational studies, non-controlled studies, and expert opinions were considered as supplementary evidence in the absence of RCTs. The strength of recommendations was classified as strong or conditional (weak). The evidence informing recommendations derives from studies worldwide, while the implementation suggestions combined the Chinese experience. The target audience of this guideline is clinician and related professionals involved in management of infectious diseases.     

《严重过敏反应急救指南》临床问题与结局指标的收集和确定

目的: 确定纳入《严重过敏反应急救指南》的临床问题与结局指标。方法: 由指南指导委员会7位临床医学、药学及护理学专家参考国际指南指导项目组起草、修订拟纳入指南的临床问题与结局指标初稿。临床问题分为背景问题与前景问题,其中背景问题在专家共识组共22位临床专家修订后直接纳入指南范围,前景问题与结局指标将通过三轮德尔菲法对共识组临床专家咨询形成终稿。研究在方法学家全程监督下完成,并通过分析积极系数、变异系数与分值频率等指标进行质量控制。结果: 问题征集初拟共纳入34个前景问题、6个背景问题及6个结局指标,背景问题经专家组修订后直接纳入指南。使用德尔菲法(Delphi method)对前景问题与结局指标的重要程度进行分级后,最终确定28个关键前景问题及6个结局指标纳入指南范围。其中,4个结局指标为关键性结局,其余2个为重要结局,纳入的28个关键前景问题分为严重过敏反应的诊断、救治准备、救治措施及救治后的管理四个部分,另有5个重要问题和1个次要问题此次未纳入指南,供指南修订或更新时参考或讨论。研究中专家响应的积极程度高,积极系数为100%;前景问题的共识程度高,4分及以上的问卷频率均≥0.75;结局指标中,病死率及疾病严重程度的共识程度高,变异系数≤15%。结论: 在全面严谨的信息收集基础上,以德尔菲法的方式确定了需要纳入《严重过敏反应急救指南》的临床问题与结局指标为该指南的后续制定工作奠定了基础。     

Single-cell transcriptome atlas reveals protective characteristics of COVID-19 mRNA vaccine

Messenger RNA (mRNA) vaccines are promising alternatives to conventional vaccines in many aspects. We previously developed a lipopolyplex (LPP)-based mRNA vaccine (SW0123) that demonstrated robust immunogenicity and strong protective capacity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in mice and rhesus macaques. However, the immune profiles and mechanisms of pulmonary protection induced by SW0123 remain unclear. Through high-resolution single-cell analysis, we found that SW0123 vaccination effectively suppressed SARS-CoV-2-induced inflammatory responses by inhibiting the recruitment of proinflammatory macrophages and increasing the frequency of polymorphonuclear myeloid-derived suppressor cells. In addition, the apoptotic process in both lung epithelial and endothelial cells was significantly inhibited, which was proposed to be one major mechanism contributing to vaccine-induced lung protection. Cell−cell interaction in the lung compartment was also altered by vaccination. These data collectively unravel the mechanisms by which the SW0123 protects against lung damage caused by SARS-CoV-2 infection.     

远志的化学成分研究Ⅲ

目的：研究远志益智安神的有效成分，为开发治疗老年痴呆症的新药及远志的质量控制奠定基础。方法：采用硅胶柱层析和Sephadex LH-20进行纯化，通过各种光谱数据进行结构鉴定。结果：从远志根皮95％乙醇提取物的石油醚萃取物和氯仿萃取物中分离得到了9个化合物，分别鉴定为α-菠甾醇葡萄糖苷(I)，α-菠甾醇葡萄糖苷-6’-0-棕榈酸酯(Ⅱ)，豆甾醇(Ⅲ)，(28Z)-三十四碳烯酸(Ⅳ)，1，7-dimethoxy-2，3-methylenedioxyxanthone(V)，1，2，3，6，7-pentamethoxyxanthone(VI)，1，2，3，7-tetramethoxyxanthone(Ⅶ)，1，3，7-trihydroxyxanthone(Ⅷ)和1，6，7-trihydroxy-2，3-dimethoxyxanthone(IX)。结论：化合物Ⅳ新化合物，化合物I、Ⅱ和Ⅷ为首次从远志属植物中分离得到，化合物Ⅲ和Ⅸ为首次从远志植物中分离得到。     

RMP-7对两性霉素B脂质体跨血脑屏障能力的药效学研究RMP-7对两性霉素B脂质体跨血脑屏障能力的药效学研究

目的研究两性霉素B脑靶向脂质体对小鼠脑膜炎的治疗作用。方法用薄膜超声法制备两性霉素B脂质体和两性霉素B脑靶向脂质体,测定其包封率和浓度;建立小鼠的脑膜炎模型,研究了两性霉素B脂质体的疗效。结果两性霉素B脂质体的包封率为(93.3±1.8)%;脑内注射白色念珠球菌2 h使小鼠形成脑膜炎模型;将两性霉素B制成脑靶向脂质体,能显著延长脑膜炎小鼠的生存期。结论与普通两性霉素B脂质体相比,两性霉素B脑靶向脂质体能显著提高对小鼠脑膜炎的治疗作用,使小鼠的存活期延长一倍。     

不同碳源对掌叶大黄毛状根生物量和蒽醌产量的影响

目的研究不同碳源对掌叶大黄毛状根生物量和蒽醌产量的影响。方法选取3个克隆的掌叶大黄毛状根和非转化根,采用统计分析方法,对7种糖作为培养基碳源时对大黄根生物量的积累和5种蒽醌类化合物的产量的影响进行了研究。结果不同糖作为碳源对大黄根生物量积累和蒽醌产量有极显著影响。大黄根类型与糖种类互作分析显示,DH 7a与麦芽糖对于蒽醌产量来说是优势组合,而DH 5a和DH 5c在蔗糖和果糖差异不显著,非转化根在蔗糖作碳源的培养基中蒽醌产量极显著地高于其他6种糖。结论果糖作为碳源最利于大黄根培养的生物量的积累,蔗糖作为碳源时大黄根蒽醌产量最高。     

不同培养基对掌叶大黄毛状根克隆系质量的影响

目的研究培养基优化和毛状根克隆系对掌叶大黄毛状根生物量和蒽醌产量的影响。方法选取4个单克隆掌叶大黄毛状根和4种基本培养基,采用统计分析方法,研究影响大黄毛状根生物量积累和5种蒽醌类化合物的产量的因素。结果不同克隆间大黄毛状根生物量积累存在显著差异,以单克隆毛状根DH 7a最高;培养基种类对毛状根生物量的影响存在极显著差异,以W P培养基中毛状根生物量最高;大黄毛状根中的5种游离蒽醌中以大黄酚和大黄素甲醚为主;不同克隆间5种游离蒽醌总产量存在显著差异,以DH 7a最高,并且DH 7a与B 5培养基的组合,5种蒽醌产量最高;克隆和培养基之间互作分析显示克隆DH 5a、DH 5d与W P培养基,克隆DH 7a与B 5培养基对于游离蒽醌产量来说是优势组合,而克隆DH 5c在4种培养基上5种游离蒽醌产量差异不显著。结论本研究为利用掌叶大黄毛状根培养系统大规模生产蒽醌类化合物提供依据。     

广藿香生药、化学及药理学的研究进展

广藿香P og ostem on cablin别名刺蕊草、藿香,以干燥地上部分入药,是著名“南药”之一,为临床上常用的芳香化湿药,具有芳香化湿、和中止呕、发表解暑的功能。近年来对广藿香进行了包括品种鉴定、化学成分、药理作用和组织培养等方面的广泛研究,阐明了广藿香的性状和显微特征,分析了影响其化学成分和量的各种因素,并对广藿香调节胃肠道功能和抗菌的药理作用进行了重点归纳。这些研究均为进一步探讨广藿香的品质评价标准、揭示其化学成分与药理作用的相关性提供了理论基础。     

反相高效液相色谱法测定抗癌新药SLXM-2的含量

 目的建立测定抗癌新药SLXM-2含量的反相高效液相色谱分析方法。方法采用C₁₈硅烷键合硅胶为填料的色谱柱(DIKMA^TM4.6mm×200mm,5μm),乙腈-水(20:80)为流动相,流速为1mL·min^-1,检测波长为199nm。结果SLXM-2的质量浓度为0.392～2.02g·L^-1内呈良好的线性关系(r=0.9998),平均回收率为99.7%(n=9);本方法的最低检出浓度为4.4mg·L^-1。结论该方法简便、准确、可靠,可用于抗癌新药SLXM-2的质量控制。     

重组水蛭素经蟾蜍肺泡膜的转运研究

 目的考察重组水蛭素跨膜转运的基本特点和影响因素,对转运的机制进行初步的探讨,为重组水蛭素肺部给药的体内评价打下理论基础。方法将蟾蜍肺泡膜作为肺液上皮体外模型,装在水平扩散池上,向给药池中加入荧光标记的重组水蛭素(FTTC-rHV₂),在不同的温度、不同的给药池初始浓度、不同的转运方向的条件下测定表观渗透系数,同时考察给药池溶液中高渗透压、酸性pH、加入渗透促进剂或者代谢抑制剂时的转运情况。同时监测膜电阻的变化。结果FTTC-rHV₂的表观渗透系数具有浓度非依赖性、温度非依赖性和方向非依赖性。酸性pH环境、高渗透压和吸收促进剂使表现渗透系数明显增加,而代谢抑制剂对袁观渗透系数没有明显的影响。3h内膜电阻没有明显的变化,说明膜的完整性得以保持。结论重组水蛭素经蟾蜍肺泡膜的转运是一个非能量依赖、非载体依赖的被动扩散过程。