内蒙古地区临床危重患者三种常见感染细菌耐药基因的检测及耐药性分析

目的:探讨内蒙古地区临床危重患者常见感染细菌耐药基因的检测及耐药性相关因素,以便临床合理运用抗菌药物,为病原菌感染的预防和控制提供依据。方法:选取2010年1月至2013年1月在我院重症监护室治疗的病例中检测出的215株细菌为研究对象,运用相关的检测手段分析细菌的耐药性和耐药基因情况。结果:经过临床的检测后得出大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌分别为85株、55株和75株,其中产ESBLs大肠埃希菌54株,非产ESBLs大肠埃希菌31株;产ESBLs肺炎克雷伯菌15株,非产ESBLs肺炎克雷伯菌40株。大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌对美罗培南、亚胺培南的敏感性最高,且在产与非产ESBLs菌株耐药上比较有差异性(P0.05);产与非产ESBLs菌株耐药基因检测方面比较无明显差异性(P0.05)。结论:大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌均存在多重耐药情况,且耐药与喹诺酮耐药机制有一定的相关性。     

减低剂量去甲氧柔红霉素联合阿糖胞苷方案治疗老年急性髓细胞白血病的临床研究

目的:探讨减低剂量去甲柔红霉素联合阿糖胞苷(IA)方案治疗老年急性髓细胞白血病(AML)患者的疗效。方法:收集我院老年急性髓细胞白血病患者62例,随机分成减低剂量IA治疗组和标准剂量IA对照组,两组均实施3+7治疗方案。治疗2个疗程,比较两组不良反应和临床疗效。结果:减低剂量IA治疗组总CR率和CCR率分别为75.0%和66.7%;标准剂量IA对照组总CR率和CCR率分别为50.0%和33.3%。减低剂量IA治疗组总生存期25+月较标准剂量IA对照组生存期23+月延长。结论:对于老年急性髓细胞白血病患者,减低剂量IA治疗方案的CR率和CCR率与标准剂量IA治疗方案相比具有明显疗效优势。     

EPICO 2.0 project. Development of educational therapeutic recommendations using the DELPHI technique on invasive candidiasis in critically ill adult patients in special situations

BackgroundAlthough there has been an improved management of invasive candidiasis in the last decade, still controversial issues remain, especially in different therapeutic critical care scenarios.AimsWe sought to identify the core clinical knowledge and to achieve high agreement recommendations required to care for critically ill adult patients with invasive candidiasis for antifungal treatment in special situations and different scenarios.MethodsSecond prospective Spanish survey reaching consensus by the DELPHI technique, conducted anonymously by electronic e-mail in the first phase to 23 national multidisciplinary experts in invasive fungal infections from five national scientific societies including intensivists, anesthesiologists, microbiologists, pharmacologists and infectious disease specialists, answering 30 questions prepared by a coordination group after a strict review of literature in the last five years. The educational objectives spanned four categories, including peritoneal candidiasis, immunocompromised patients, special situations, and organ failures. The agreement among panelists in each item should be higher than 75% to be selected. In a second phase, after extracting recommendations from the selected items, a meeting was held with more than 60 specialists in a second round invited to validate the preselected recommendations.Measurements and main resultsIn the first phase, 15 recommendations were preselected (peritoneal candidiasis (3), immunocompromised patients (6), special situations (3), and organ failures (3)). After the second round the following 13 were validated: Peritoneal candidiasis (3): Source control and early adequate antifungal treatment is mandatory; empirical antifungal treatment is recommended in secondary nosocomial peritonitis with Candida spp. colonization risk factors and in tertiary peritonitis. Immunocompromised patients (5): consider hepatotoxicity and interactions before starting antifungal treatment with azoles in transplanted patients; treat candidemia in neutropenic adult patients with antifungal drugs at least 14 days after the first blood culture negative and until normalization of neutrophils is achieved. Caspofungin, if needed, is the echinocandin with most scientific evidence to treat candidemia in neutropenic adult patients; caspofungin is also the first choice drug to treat febrile candidemia; in neutropenic patients with candidemia remove catheter. Special situations (2): in moderate hepatocellular failure, patients with invasive candidiasis use echinocandins (preferably low doses of anidulafungin and caspofungin) and try to avoid azoles; in case of possible interactions review all the drugs involved and preferably use anidulafungin. Organ failures (3): echinocandins are the safest antifungal drugs; reconsider the use of azoles in patients under renal replacement therapy; all of the echinocandins to treat patients under continuous renal replacement therapy are accepted and do not require dosage adjustment.ConclusionsTreatment of invasive candidiasis in ICU patients requires a broad range of knowledge and skills as summarized in our recommendations. These recommendations may help to optimize the therapeutic management of these patients in special situations and different scenarios and improve their outcome based on the DELPHI methodology.     

我国优秀散打运动员与几种疾病患者的手纹比较研究

通过对我国优秀散打运动员的手纹与几种疾病患者的手纹研究结果进行比对。发现我国优秀散打运动员手纹和胃癌、肺癌、食管癌患者的手纹特征相似,其斗型纹(W)增加和尺箕(Lu)减少的发展趋势一致。用统计学方法对相关指标数据分析,均与参照组、对照组具有显著性差异。建议优秀散打运动员合理饮食,重视预防以上恶性病变的发生。     

Zinc kinetics in insulin-dependent diabetes mellitus patients

Zinc has an important role in the control of carbohydrate metabolism, and diabetic patients are at risk for zinc deficiency. However, there are conflicting data concerning nutritional zinc status. In order to investigate this topic, 10 normal and 10 insulin-dependent diabetic patients were studied following venous zinc tolerance test. Our results found no evidence of zinc deficiency or of changes on the kinetic parameters of zinc in patients with insulin-dependent diabetes mellitus following a venous zinc tolerance test.     

乙肝患者抗HBs独特型抗体特异性免疫复合物的检测与意义

根据用终浓度分别为35.0g/L和17.5g/L聚乙二醇沉淀循环免疫复合物,去除游离抗HBs-Ab_2,再以胰蛋白酶解离复合物的原理,建立了检测抗HBs-Ab_2-ICs的ELISA法。结果表明,38例急性乙型肝类和83例慢性活动性乙肝患者的IgG、IgM类抗HBs-Ab_2-ICs总阳性率分别为13.2％(5/38)和18.1％(15/83)。IgG、IgM类抗HBs-Ab_2-ICs检出率无显著差异(P>0.05)。实验证实乙肝患者体内存在含抗HBs-Ab_2-ICs。提示抗HBs-Ab_2尚可与抗HBs结合,抑制其中和HBV的作用而利于HBV复制。     

PICCO在老年髋关节手术麻醉及血流动力学优化中的应用

目的:探讨脉搏指示持续心输出量(pulse induced contour crdic output,PICCO)技术在老年髋关节手术麻醉及血流动力学优化中的临床应用。方法:将106例老年髋关节手术患者随机分成2组,每组各53例。常规组放置中心静脉导管和动脉导管,PICCO组放置PICCO,检测平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)、心率(heart rate,HR)、心指数(cardiac index,CI)、血管外肺水指数(extravascular lung water index,ELWI)、胸腔内血容量指数(intrathoracic blood volume index,ITBI)及肺血管通透性指数(pulmonary vascular permeability index,PVPI)等血流动力学参数。记录PICCO组术中各指标的变化,比较分析两组术后前3天液体输入量,术后并发症发生情况。结果:与T0时点比较,PICCO组T1时点的MAP、CVP、CI、ITBI明显降低,HR明显升高(P0.05);T2时点MAP、CVP、CI较T1明显升高,HR明显下降(P0.05);PICCO组T2时刻各血流动力学指标均明显优于常规组(P0.05)。PICCO组术后前3天的液体入量明显少于常规组(P0.05);ELWI与PVPI、ITBI、液体入量均呈高度正相关(P0.05)。且PICCO组术后肺部感染及心血管并发症的发生率也较常规组明显降低(P0.05)。结论:PICCO监测可准确反映血流动力学状态参数,指导临床麻醉和围术期液体管理,减少术中术后不良并发症,改善患者预后。     

Animal models of human-derived cancer vaccines

Preclinical cancer vaccine studies must address vaccine safety, immunogenicity, and efficacy, as well as mechanism of vaccine action. Animal models of vaccines employing human tumor-associated antigen or epitopes (TAA, TAE) differ fundamentally from those employing tumor-specific antigens or epitopes (TSA, TSE). TSA and TSE vaccines will most likely demonstrate similar toxicity, immunogenicity, and efficacy in both tumor-bearing animals and patients. In contrast, TAA/TAE immunizations may have to overcome a host’s immunological tolerance to TAA/TAE expressed not only on tumor, but also on normal tissues; immunity to TAA/TAE will potentially target normal tissues and thus may induce autoimmunity. Various experimental models for human-derived TAA/TAE vaccines have been developed. These models include transgenic mice, mice with severe combined immunodeficiency (SCID), and non-human primates. Recently, unique animal models of TAA/TAE cancer vaccines have been developed, taking advantage of the discovery of animal tissue antigens with significant sequence homologies to human TAA/TAE. These models mimic perhaps most closely the situation in cancer patients.     

Determination of the enantiomers of citalopram,its demethylated and propionic acid metabolites in human plasma by chiral HPLC

A stereoselective HPLC assay has been developed to analyze the enantiomers of citalopram and of its three main metabolites in plasma after their separation on a Chiracel OD column. Using a fluorescence detector, the limit of quantification in plasma samples was 15, 4, 5, and 2 ng/ml for the enantiomers of citalopram (CIT), desmethylcitalopram (DCIT), didesmethylcitalopram (DDCIT), and for the citalopram propionic acid derivative (CIT-PROP), respectively. Except for CIT, all metabolites were derivatized with achiral reagents. Identification of the enantiomers was realized with an optical rotation detector which showed that the enantiomers invert their rotation depending on the polarity and nature of the solvent. Under varying conditions, a racemization study has shown that the pure enantiomers of CIT and its demethylated metabolites are configurationally stable. Preliminary results obtained with five patients treated with CIT show a mean S/R ratio of 0.7 for both CIT and its active metabolite DCIT and of 3.6 for CIT-PROP in plasma. This suggests that the pharmacologically relevant (+)-(S)-isomers of CIT and DCIT could be preferentially and steroselectively metabolized to CIT-PROP. © 1995 Wiley-Liss, Inc.     

A Microassay for Determination of the Cytopathogenicity of Human Immunodeficiency Virus Type-1 Isolates

Correlations between the in vitro biological properties of HIV strains isolated from patients and the prognosis of their disease have been reported. We developed a technique to study the phenotype of HIV strains isolated from patients. We used the P4 cell line, derived from HeLa cells, which has been transfected with receptor CD4 gene. HIV laboratory strain (HIV_LAI) and peripheral blood leukocytes (PBLs) from donors infected with HIV_LAI induce syncytium in P4 cell cultures in vitro. The presence of reporter gene (LacZ gene) under the control of the HIV-1 long terminal repeat (LTR) in these cells allows colorimetric visualization of syncytia in the cytoplasm using a β-galactosidase (βgal) assay in the presence of X-gal. We cocultivated 1 × 10⁶ patient PBLs with 2 × 10⁶ normal PHA-activated normal PBLs for 4 days in the presence of IL-2 in 24-well plates. Half of the medium was replaced twice a week and PHA-activated normal PBLs were added every 7 days. HIV-1 was isolated from cocultured PBLs of 18 patients with advanced-stage HIV infection as assessed by the production of HIV p24 detected with a commercially available HIV-1 p24 ELISA. Supernatant and 10⁵ cells were collected twice a week from cocultured PBLs and were added to P4 cells in 96-well microtiter plates. The cultures were observed every day for 3 days and then the βgal assay was performed. We did not observe any effect with cells and supernatant from 8 patients, harvested from cultures incubated for as long as 28 days. The phenotype of these isolates was called NC (noncytopathic). In cells from 2 patients, we obtained blue multinucleated giant cells; the phenotype of these strains was called SI (syncytium inducing). In cultures from 8 other patients, we obtained the death of P4 cells without syncytium formation, and the phenotype of these strains was called CI (cell-killing inducing). In every case, the cytopathic effect of HIV-1 isolates could be detected with cocultured PBLs collected as early as day 4 of culture. Cocultured PBLs from 13 healthy controls did not alter the P4 cells. We displayed the replication of CI strains of HIV-1, but not the one of NC strains in P4 cell line. Our micromethod allowed the detection of cytopathic effects of HIV isolates. Further investigations should define the clinical applications of this method.