Modelling the epidemiology of hepatitis B in New Zealand

Hepatitis B is a vaccine preventable disease caused by the hepatitis B virus (HBV) that can induce potentially fatal liver damage. It has the second highest mortality rate of all vaccine preventable diseases in New Zealand. Vaccination against HBV was introduced in New Zealand in 1988, and the country is now categorised with overall low endemicity but with areas of both high and medium endemic levels. We present an SECIR compartmental mathematical model, with the population divided into age classes, for the transmission of HBV using local data on incidence of infection and vaccination coverage. We estimate the basic reproduction number, R₀, to be 1.53, and show that the vaccination campaign has substantially reduced this below one. However, a large number of carriers remain in the population acting as a source of infection.     

Drug resistance in tuberculosis--a reinfection model

There is increasing recognition that reinfection is an important component of TB transmission. Moreover, it has been shown that partial immunity has significant epidemiological consequences, particularly in what concerns disease prevalence and effectiveness of control measures. We address the problem of drug resistance as a competition between two types of strains of Mycobacterium tuberculosis: those that are sensitive to anti-tuberculosis drugs and those that are resistant. Our objective is to characterise the role of reinfection in the transmission of drug-resistant tuberculosis. The long-term behaviour of our model reflects how reinfection modifies the conditions for coexistence of sensitive and resistant strains. This sets the scene for discussing how strain prevalence is affected by different control strategies. It is shown that intervention effectiveness is highly sensitive to the baseline epidemiological setting.     

多粘菌素耐药性的研究进展

多粘菌素因在多重耐药革兰氏阴性菌上的治疗效果良好,再度被应用于临床,其耐药水平在多种抗菌药中曾一度较低,但目前有研究表明多粘菌素的耐药率有增加趋势。作为抗击多重耐药革兰氏阴性菌的最后一道防线,如何抑制其耐药的发生就显得尤为重要。本文就多粘菌素的耐药性现状、产生机制及防控措施三个方面进行了综述,为指导临床科学合理使用多粘菌素及革兰氏阴性菌耐药菌株传播和蔓延的防控措施提供理论依据。     

Modelling the effect of the redox potential and pH of heating media on Listeria monocytogenes heat resistance

Aims:  Study the effect of redox potential and pH of the heating media on Listeria monocytogenes heat resistance and model its action at fixed temperature.
Methods and Results:  The heat resistance of Listeria monocytogenes at 58°C was studied in Brain Heart Infusion broth as a function of pH (from 5·0 to 7·0) and redox potential ( E _h7). The media redox was adjusted with nitrogen gas, potassium ferricyanide and dithiothreitol. A Weibull model was used to fit survival curves. The heat resistance parameter (δ_58°C) was estimated from each inactivation curve. A major effect of pH was observed. Bigelow model was used to describe the effect of redox potential on the apparent L. monocytogenes heat resistance. The highest δ_58°C values have been obtained at pH 7·0 and oxidizing conditions.
Conclusions:  The developed model indicates that the E _h7 has a significant effect and varied depending on the pH of the heating media. The z _redox values, calculated from δ_58°C allowed quantifying the influence of heating media redox potential on L. monocytogenes thermal inactivation.
Significance and Impact of the Study:  The obtained model shows the action of redox potential on L. monocytogenes thermal destruction and might be useful to take into account in food thermal processes.     

Autophagy and chemotherapy resistance: a promising therapeutic target for cancer treatment

Induction of cell death and inhibition of cell survival are the main principles of cancer therapy. Resistance to chemotherapeutic agents is a major problem in oncology, which limits the effectiveness of anticancer drugs. A variety of factors contribute to drug resistance, including host factors, specific genetic or epigenetic alterations in the cancer cells and so on. Although various mechanisms by which cancer cells become resistant to anticancer drugs in the microenvironment have been well elucidated, how to circumvent this resistance to improve anticancer efficacy remains to be defined. Autophagy, an important homeostatic cellular recycling mechanism, is now emerging as a crucial player in response to metabolic and therapeutic stresses, which attempts to maintain/restore metabolic homeostasis through the catabolic lysis of excessive or unnecessary proteins and injured or aged organelles. Recently, several studies have shown that autophagy constitutes a potential target for cancer therapy and the induction of autophagy in response to therapeutics can be viewed as having a prodeath or a prosurvival role, which contributes to the anticancer efficacy of these drugs as well as drug resistance. Thus, understanding the novel function of autophagy may allow us to develop a promising therapeutic strategy to enhance the effects of chemotherapy and improve clinical outcomes in the treatment of cancer patients.     

Modeling within-host HIV-1 dynamics and the evolution of drug resistance: trade-offs between viral enzyme function and drug susceptibility

There are many biological steps between viral infection of CD4(+) T cells and the production of HIV-1 virions. Here we incorporate an eclipse phase, representing the stage in which infected T cells have not started to produce new virus, into a simple HIV-1 model. Model calculations suggest that the quicker infected T cells progress from the eclipse stage to the productively infected stage, the more likely that a viral strain will persist. Long-term treatment effectiveness of antiretroviral drugs is often hindered by the frequent emergence of drug resistant virus during therapy. We link drug resistance to both the rate of progression of the eclipse phase and the rate of viral production of the resistant strain, and explore how the resistant strain could evolve to maximize its within-host viral fitness. We obtained the optimal progression rate and the optimal viral production rate, which maximize the fitness of a drug resistant strain in the presence of drugs. We show that the window of opportunity for invasion of drug resistant strains is widened for a higher level of drug efficacy provided that the treatment is not potent enough to eradicate both the sensitive and resistant virus.     

淋巴瘤化疗后继发感染患者病原菌及耐药性分析

分析淋巴瘤化疗后继发感染患者病原菌分布及病原菌对常见抗菌药物的敏感性,从而为制定患者干预方案、提高患者生活质量提供参考依据。

以经病理确诊的淋巴瘤化疗后继发感染患者为研究对象,采集患者血液、尿液、痰液和粪便样本。采用VITEK 2 COMPACT全自动微生物鉴定及药敏分析仪鉴定病原菌种类,采用Mueller-Hinton琼脂平板和Kirby-Bauer纸片扩散法测定分离的主要病原菌菌株对常见抗菌药物的敏感性。

455例淋巴瘤病人,总计住院1 776人次,累计有356人次发生化疗后继发感染,发生率为20.1%。累计培养出病原菌106株,以大肠埃希菌和肺炎克雷伯菌为主。大肠埃希菌对头孢替坦、阿米卡星、亚胺培南、美罗培南、厄他培南敏感性均＞95%;肺炎克雷伯菌对阿米卡星、头孢替坦、亚胺培南、美罗培南、厄他培南敏感性均＞90%;金黄色葡萄球菌对呋喃妥因、利奈唑胺、替加环素、万古霉素、喹奴普汀/达福普汀敏感性均为100%;铜绿假单胞菌对多黏霉素B敏感性为100%,对哌拉西林/他唑巴坦、头孢吡肟、阿米卡星、庆大霉素、妥布霉素、亚胺培南敏感性均达87.5%。

淋巴瘤住院患者化疗后继发感染发生率较高,大肠埃希菌和肺炎克雷伯菌为主要病原菌,大肠埃希菌和肺炎克雷伯菌对阿米卡星、头孢替坦、亚胺培南、美罗培南、厄他培南敏感性较高。

     

结核分枝杆菌的耐药基因及其相关分子机制

结核分枝杆菌原发性和继发性耐药是当前控帝】和治疗结核病面临的重要问题,随着分子遗传学的发展,已经阐明了结核分枝杆菌耐药的分子基础是染色体的突变,影响了药靶本身或激活了药物前体的细菌酶,造成MTB的耐药。本文主要就MTB对其常用药物的耐药机制展开讨论,以便正确认识MTB对不同药物的耐药机制,建立快速检测耐药结核分枝杆菌基因型的分子生物学方法。     

Expression of nuclear XIAP associates with cell growth and drug resistance and confers poor prognosis in breast cancer

Evasion from apoptosis is one of the hallmarks of cancer. X-linked inhibitor of apoptosis protein (XIAP) is known to modulate apoptosis by inhibiting caspases and ubiquitinating target proteins. XIAP is mainly found at the cytoplasm, but recent data link nuclear XIAP to poor prognosis in breast cancer. Here, we generated a mutant form of XIAP with a nuclear localization signal (XIAP^NLS-C-term) and investigated the oncogenic mechanisms associated with nuclear XIAP in breast cancer. Our results show that cells overexpressing XIAP^ΔRING (RING deletion) and XIAP^NLS-C-term exhibited XIAP nuclear localization more abundantly than XIAP^wild-type. Remarkably, overexpression of XIAP^NLS-C-term, but not XIAP^ΔRING, conferred resistance to doxorubicin and increased cellular proliferative capacity. Interestingly, Survivin and c-IAP1 expression were not associated with XIAP oncogenic effects. However, NFκB expression and ubiquitination of K63, but not K48 chains, were increased following XIAP^NLS-C-term overexpression, pointing to nuclear signaling transduction. Consistently, multivariate analysis revealed nuclear, but not cytoplasmic XIAP, as an independent prognostic factor in hormone receptor-negative breast cancer patients. Altogether, our findings suggest that nuclear XIAP confers poor outcome and RING-associated breast cancer growth and chemoresistance.     

Gene copy-number changes and chromosomal instability induced by aneuploidy confer resistance to chemotherapy

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大连市伤寒沙门菌耐药性及耐药基因分析

目的检测多重耐药伤寒沙门菌对抗菌药物的敏感性及其耐药基因携带情况,为伤寒沙门菌引起的腹泻治疗提供科学依据。方法采用微量肉汤稀释的方法测定大连地区临床分离的78株伤寒沙门菌对12种抗生素的敏感性;用PCR方法检测TEM型β内酰胺酶基因、catA和catB氯霉素乙酰基转移酶基因以及cmlA氯霉素外排泵蛋白基因、aac(6′)Ⅰb和aac3Ⅱ型氨基糖苷类修饰酶基因、qacEΔ1sul1耐消毒剂和磺胺基因、多重耐药外排基因acrB等8种耐药基因。结果78株沙门菌对12种药物有不同程度耐药(1.28%~74.35%)。得到9株多重耐药菌株,其中5株检出TEM型β内酰胺酶基因;7株耐氯霉素的伤寒沙门菌菌株中,2株仅检出catA基因,1株仅检出catB基因,1株仅检出cmlA氯霉素外排泵蛋白基因,2株同时检出catA基因和cmlA氯霉素外排泵蛋白基因;2株检出aac(6′)Ⅰb基因,1株检出aac3Ⅱ型氨基糖苷类修饰酶基因;4株检出耐消毒剂和磺胺基因qacEΔ1sul1;6株检出多重耐药外排基因acrB。结论大连地区临床分离的伤寒沙门菌存在严峻的耐药现象,多种耐药基因存在于耐药伤寒沙门菌中,可能是导致菌株对多种抗菌药物耐药的原因。     

结核分枝杆菌的耐药基因及其相关分子机制

结核分枝杆菌原发性和继发性耐药是当前控制和治疗结核病面临的重要问题,随着分子遗传学的发展,已经阐明了结核分枝杆菌耐药的分子基础是染色体的突变,影响了药靶本身或激活了药物前体的细菌酶,造成MTB的耐药。本文主要就MTB对其常用药物的耐药机制展开讨论,以便正确认识MTB对不同药物的耐药机制,建立快速检测耐药结核分枝杆菌基因型的分子生物学方法。     

6038例儿科临床标本深部真菌检出率及其药敏分析

目的了解儿童常见深部真菌的种类及耐药状况,指导临床合理用药。方法对785株深部真菌用YBC鉴定卡鉴定到种,用ATB-FUNGS试剂盒进行药物敏感试验。结果785株真菌中自色念珠菌占72．2％,其次是光滑念珠菌、热带念珠菌、克柔念珠菌,分别占17．2％、8．7％、1．3％。呼吸科、心内科、新生儿科、血液科真菌的检出率分别为：30．1％、13．5％、13．1％、12．1％;785株真菌对5-氟胞嘧啶、两性霉素B、制霉菌素、咪康唑、益康唑、酮康唑总的敏感率分别为93．2％、85．2％、87．4％、30．5％、61．8％、45．4％。结论儿童深部真菌以白色念珠菌最多。785株真菌对5-氟胞嘧啶、两性霉素B、制霉菌素的敏感性较高,它们仍然是治疗深部真菌感染的有效药物,而咪康唑、益康唑、酮康唑的敏感性较低,应引起临床医生的重视。     

嗜麦芽寡养单胞菌临床分布特征与耐药分析

目的了解湖州市中心医院嗜麦芽寡养单胞菌临床分布特征与耐药性。方法采用常规方法分离,用VITE-COMPACT2全自动微生物分析仪进行菌种鉴定,用K—B法进行药敏试验。结果分离到嗜麦芽寡养单胞菌810株,复方新诺明耐药菌株48株（分离率5．9％）。标本来源主要来自ICU室,其次呼吸科,大部分来自痰液标本（约占89．2％）,年龄段以中老年人比率最高。嗜麦芽寡养单胞菌对亚胺培南、美罗培南、头孢吡肟、哌拉西彬他坐巴坦、庆大霉素、妥布霉素、阿米卡星高度耐药;头孢他啶、替卡西林／克拉维酸、环丙沙星耐药率为33．7％～58．2％;头孢哌酮／舒巴坦、左氧氟沙星、米诺环素、复方新诺明耐药率低于30．0％。复方新诺明耐药菌株对头孢哌酮／舒巴坦、左氧氟沙星和米诺环素耐药率分别为60．4％、91．7％和2．0％,对其余抗菌药物耐药率达100．0％。复方新诺明耐药菌株与复方新诺明敏感菌株相比,耐药情况更严重,其中对三、四代头孢菌素、喹诺酮类耐药率显著高于复方新诺明敏感菌株（P〈0．01）;对碳青霉烯类、青霉素类、氨基糖苷类抗菌药物耐药率与复方新诺明敏感菌株相比,差异无统计学意义（P〉0．05）。结论嗜麦芽寡养单胞菌呈高度耐药,对头孢哌酮／舒巴坦、左氧氟沙星、米诺环素、复方新诺明尚敏感,但对复方新诺明耐药的嗜麦芽寡养单胞菌耐药现象更严重。应重视嗜麦芽寡养单胞菌引起的院内感染,尽量减少不必要的侵人性操作,加强抗菌药物的合理规范使用。     

SOX方案与FOLFOX4治疗进展期胃癌的临床疗效、毒副作用及生存时间比较研究

目的:探讨SOX方案与FOLFOX4治疗进展期胃癌的临床疗效、毒副作用及生存时间。方法:选取2013年10月到2014年10月期间唐山市人民医院收治的进展期胃癌患者90例作为研究对象,根据随机数字表法将其分为SOX组与FOLFOX4组,两组均为45例。SOX组患者给予奥沙利铂+替吉奥胶囊进行治疗,FOLFOX4组给予奥沙利铂+亚叶酸钙+氟尿嘧啶进行治疗。比较两组患者的疾病缓解率、疾病控制率、毒副反应、1年生存率、2年生存率和3年生存率。结果:两组患者的的疾病缓解率和疾病控制率经统计分析差异均无统计学意义(P0.05)。两组患者红细胞下降、血小板下降、腹泻、外周神经症状、手足综合征、肝功能异常发生率比较差异均无统计学意义(P0.05),FOLFOX4组I-II级白细胞下降、恶心呕吐的发生率高于SOX组(P0.05),两组III-IV级白细胞下降、恶心呕吐的发生率比较差异无统计学意义(P0.05)。两组患者的1年生存率、2年生存率、3年生存率经统计分析差异均无统计学意义(P0.05)。结论:SOX方案与FOLFOX4治疗进展期胃癌的临床疗效相近,且患者的生存时间无明显差异,但SOX方案的白细胞下降、恶心呕吐等毒副反应程度较轻。     

407例老年肺癌下呼吸道感染患者病原菌分布及耐药分析

目的 分析老年肺癌下呼吸道感染患者痰培养物的病原菌分布及耐药状况.方法 回顾性分析407例老年肺癌下呼吸道感染患者痰标本细菌培养、鉴定及药敏结果.结果 共分离出病原菌238株,革兰阴性菌163株,占68.49％;革兰阳性菌33株,占13.87％;真菌42株,占17.65％.主要病原菌为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、表皮葡萄球菌和金黄色葡萄球菌.其中,肺炎克雷伯菌和大肠埃希菌ESBLs阳性菌株的比例分别为36.73％、28.85％.结论 老年肺癌患者因长期使用抗生素,呼吸道菌群失调,不同病原菌对抗菌药耐药率均较高,以革兰阴性菌感染为主,肺炎克雷伯菌和大肠埃希菌产ESBLs的菌株有较高比例,二重感染比例较高;革兰阳性菌均对万古霉素敏感,未发现耐药菌株.因此临床医生根据药敏结果合理选用抗生素,对于改善患者肺部微生态失衡,延长生存时间具有重要指导意义.     

2009年度宁波市妇儿医院主要病原菌的临床分布及耐药性分析

目的了解宁波市妇儿医院主要病原菌的临床分布及耐药性分析。方法血液培养采用法国生物梅里埃公司的BacT/Alert3D,菌株鉴定采用法国生物梅里埃公司的VITEK 60分析仪,药敏试验采用K-B法,纸片扩散确证试验检测ESBLs。结果前10位细菌构成比依次是大肠埃希菌(13.4%)、白色念珠菌(8.7%)、阴道加德纳菌(7.8%)、表皮葡萄球菌(6.9%)、金黄色葡萄球菌(5.6%)、肺炎克雷伯菌(4.9%)、鲍曼复合醋酸钙不动杆菌(3.9%)、粪肠球菌(D群)(3.1%)、铜绿假单胞菌(2.7%)和溶血葡萄球菌(2.0%)。大肠埃希菌539株中产ESBLs阳性率为52.5%,肺炎克雷伯菌195株中产ESBLs阳性率为45.2%。大肠埃希菌主要分离于尿液,其次是脓液/切口。肺炎克雷伯菌在痰及咽拭子中所占比例最高。46株铜绿假单胞菌和11株鲍曼复合醋酸钙不动杆菌对亚胺培南耐药。结论对产ESBLs的肺炎克雷伯菌和大肠埃希菌、耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)、耐亚胺培南的鲍曼复合醋酸钙不动杆菌和铜绿假单胞菌,应加强隔离预防,控制在医院内的扩散,减少耐药菌株产生。     

Optimal policies of non-cross-resistant chemotherapy on Goldie and Coldman’s cancer model

Mathematical models can be used to study the chemotherapy on tumor cells. Especially, in 1979, Goldie and Coldman proposed the first mathematical model to relate the drug sensitivity of tumors to their mutation rates. Many scientists have since referred to this pioneering work because of its simplicity and elegance. Its original idea has also been extended and further investigated in massive follow-up studies of cancer modeling and optimal treatment.     

Human colonic fibroblasts regulate stemness and chemotherapy resistance of colon cancer stem cells

There is increasing evidence that cancers are heterogeneous and contain a hierarchical organization consisting of cancer stem cells and their differentiated cell progeny. These cancer stem cells are at the core of the tumor as they represent the clonogenic cells within a tumor. Moreover, these cells are considered to contain selective therapy resistance, which suggests a pivotal role in therapy resistance and tumor relapse. Here we show that differentiated cells can re-acquire stemness through factors secreted from fibroblasts. This induced CSC state also coincides with re-acquisition of resistance to chemotherapy. Resistance induced in newly formed CSCs is mediated by the anti-apoptotic molecule BCLXL and inhibition of BCLXL with the BH3 mimetic ABT-737 sensitizes these cancer cells toward chemotherapy. These data point to an important interplay between tumor cells and their microenvironment in the regulation of stemness and therapy resistance.