Objectives‘National Special Stewardship in the Clinical Use of Antibiotics’ was put forward in July 2011 in China. We aimed to retrospectively evaluate the impact of antimicrobial stewardship (AMS) managed by clinical pharmacists on antibiotic utilisation, prophylaxis and antimicrobial resistance (AMR).DesignThis was a retrospective observational study of trends in antibiotic use and AMR in the context of AMS.SettingBeijing Chaoyang Hospital, a 1400-bed tertiary hospital, in China.Data and participantsAntibiotic prescriptions from 820 doctors included all outpatients (n=17 766 637) and inpatients (n=376 627) during 2010–2016. Bacterial resistance data were from all inpatients (n=350 699) during 2011–2016.InterventionsMultiaspect intervention measures were implemented by clinical pharmacists (13 persons), for example, formulating the activity programme and performance management, advising on antibacterial prescriptions and training.Outcome measuresThe proportion of antibiotic prescriptions among outpatients and inpatients, intensity of consumption in defined daily dose (DDD)/100 bed-days, antibiotic prophylaxis in type I incision operations and resistance rates ofEscherichia coli,Klebsiella pneumoniaeandPseudomonas aeruginosawere retrospectively analysed.ResultsThe proportion of antibiotic prescriptions decreased in outpatients (from 19.38% to 13.21%) and in inpatients (from 64.34% to 34.65%), the intensity of consumption dropped from 102.46 to 37.38 DDD/100 bed-days. The proportion of antibiotic prophylaxis decreased from 98.94% to 18.93%. The proportion of rational timing of initial dose increased from 71.11% to 96.74%, the proportion of rational duration rose from 2.84% to 42.63%. Time series analysis demonstrated the resistance rates ofE. coliandP. aeruginosato fluoroquinolones decreased, the incidence rate of methicillin-resistantStaphylococcus aureusalso decreased, whereas the resistance rates ofE. coliandK. pneumoniaeto carbapenems increased. The antibiotic use was partly positively correlated with AMR.ConclusionsAMS had an important role in reducing antibiotic use and surgical antibiotic prophylaxis. The AMR was positively correlated with antibiotic consumption to some extent.

Precise control of the motion of micromachines is the key to achieving their functions for practical applications. The main challenge is that a given micromachine can typically exhibit only one motion mode, i.e., translation or rotation, while having multiple modes of motion resulting from a simple actuation is still rare. Here we designed and synthesized photochemically powered zinc oxide/gold (ZnO/Au) rods that exhibit multiple motion modes. Under homogeneous UV irradiation, these ZnO/Au rods undergo a transition from ballistic motion to persistent rotational motion upon increasing the fuel concentration or the light intensity. In addition, the rods can switch modes from a circular motion to a helical motion and then a straight-line motion by tuning the angle of incident light. We envision that such attractive colloidal micromachines with controllable motions hold considerable promise for diverse practical applications.

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Microgels are soft particles that can be deformed and compressed, which would induce intriguing phase behaviors at high packing fractions. Poly(N-isopropylacrylamide) (PNIPAM) microgels, with a lower critical solution temperature (LCST) of 33 °C, have attracted considerable interests as model colloids, since the volume of them and the interaction between the microgels can be tuned precisely by temperature. In this work, the linear viscoelastic properties of PNIPAM microgel suspensions have been investigated using mechanical spectroscopy. A particular attention is focused on the phase behaviors at high concentrations. With increasing concentration the system undergoes a repulsive glass-to-gel transition below the LCST, while, as temperature is raised across the LCST, the system undergoes a gel-to-attractive glass transition. A mechanism of these transitions for the microgels is proposed based on the directional interaction between the particles. In moderate concentration or de-swelling microgels the interaction is isotropic leading to the glass phase, while in concentrated and deformed microgels the interaction is directional leading to the gel phase. Our results enrich the current understanding of the phase transition in microgel systems and shed new light on the phase diagram of colloidal suspensions in general.

The longer segmental dynamics of sub-Rouse modes in polystyrene with different molecular weights has been investigated by 2D correlation mechanical spectroscopy. The sub-Rouse modes were first separated from the α relaxation and Rouse modes, and their dynamics exhibits a similar change at the same temperature, T(B) ≈ 1.2T(g), as the α relaxation. The relaxation time of sub-Rouse modes at T(B) is independent of molecular weight and has a value of about 0.1 s, indicating that solely the time scale of the relaxation determines the change in dynamics of sub-Rouse modes. According to the coupling model, the change is caused by a strong increase in intermolecular cooperativity. The present work provides direct evidence for the intermolecular coupled nature of the sub-Rouse modes and demonstrates that the properties of the sub-Rouse modes resemble those of α relaxation, which could provide a new perspective for understanding the glass transition of polymers.

Studies have suggested that glutamine synthetase (GS) is a potential marker of hepatocellular carcinoma (HCC). We aimed to evaluate the expression of GS in non-malignant liver tissue and serum GS levels in HCC, liver cirrhosis (LC), chronic hepatitis B (CHB), five kinds of extrahepatic diseases patients and healthy subjects. Immunohistochemistry (IHC) was used to assess GS expression in 260 liver tissue samples (from 120 HCC, 90 CHB stage 4, and 50 CHB stage 1-3 patients). Enzymelinked immunosorbent assays of 325 samples (from 100 healthy donors, 33 CHB stage 1-3, 43 CHB stage 4, 111 HCC, and 45 extrahepatic diseases patients) were used to further analyze GS levels in serum. IHC studies showed the expression of GS in 70% of HCC patients, 46.7% of CHB stage 4 patients and 38% of CHB stage 1-3 patients. The v 2 tests showed significant difference between HCC samples and non-tumor tissues (P = 0.001 for HCC vs. CHB stage 4, P = 0.000 for HCC vs. CHB). Consistent with this, serum GS levels are increased in HCC and CHB stage 1-4 patients. There are significant differences among all samples (P = 0.000 for all), except CHB stage 1-3 versus CHB stage 4 (P = 0.552). Based on multiple linear regressions, HCC, CHB stage 1-4 and AFP were significantly associated with serum GS levels. In addition, in HCC group, TNM and Child-Pugh were significantly associated with GS levels. Expression of GS is increased in HCC, LC, and CHB. It may be a new serum marker for liver disease.Keywords Glutamine synthetase Á Hepatocellular carcinoma Á Liver cirrhosis Á Chronic hepatitis B Á Regeneration Á Receiver operating characteristic curve Á Sensitivity and specificity Abbreviations