Ventilator associated pneumonia and infection control

Rifampicin, an important drug in the treatment of tuberculosis, is used extensively despite its broad effects on drug-drug interactions, creating serious problems. The clinical importance of such interactions includes autoinduction leading to suboptimal or failed treatment. The concomitantly administered effects of rifampicin on other drugs can result in their altered metabolism or transportation that are metabolised by cytochromes P450 or transported by p-glycoprotein in the gastrointestinal tract and liver. This review paper summarises recent findings with emphases on the molecular mechanisms used to explain these broad drug-drug interactions. In general, rifampicin can act on a pattern: rifampicin activates the nuclear pregnane X receptor that in turn affects cytochromes P450, glucuronosyltransferases and p-glycoprotein activities. This pattern of action may explain many of the rifampicin inducing drug-drug interactions. However, effects through other mechanisms have also been reported and these make any explanation of such drug-drug interactions more complex.     

呼吸机的故障分析及管理措施

统计了2009-2010年本院40台呼吸机机械通气时的故障的类型及各种类型故障所占的百分比。分析了故障产生的原因,提出如何从管理措施方面着手,以达到降低故障率,提高设备寿命为目的。     

Purification and reconstitution of an outwardly rectified Cl- channel from tracheal epithelia

We reported the identification of three outwardly rectifiedCl channel (ORCC) candidateproteins (115, 85, and 52 kDa) from bovine tracheal epithelia. We haveraised polyclonal antibodies against these isolated proteins.Incorporation into planar lipid bilayers of material partly purifiedfrom bovine tracheal apical membranes with one of these antibodies as aligand (anti-p115) resulted in the incorporation of an ORCC identicalin biophysical characteristics to one we previously described. Wedeveloped a new purification procedure to increase the yield and purityof this polypeptide. The purification scheme that gave the best results in terms of overall protein yield and purity was a combination ofanion- and cation-exchange chromatography followed byimmunopurification. By use of this purification scheme, 7 µg of the115-kDa protein were purified from 20 mg of tracheal apical membraneproteins. Incorporation of this highly purified material into planarlipid bilayers revealed a DIDS-inhibitable channel with the following properties: linear conductance of 87 ± 9 pS in symmetricalCl solutions, halideselectivity sequence of I > Cl > Br, and lack of sensitivityto protein kinase A, Ca²⁺, ordithiothreitol. Using anti-G_iantibodies to precipitate G_iprotein(s) from the partly purified preparations, we demonstrated thatthe loss of rectification of the ORCC was due to uncoupling ofG_i protein(s) from the ORCCprotein and that the 115-kDa polypeptide is an ORCC.

     

心理辅助治疗在机械通气治疗中的作用

目的:了解心理辅助治疗对于机械通气患者治疗过程中的重要作用.方法:对收治的38例机械通气患者在常规治基础上进行心理及行为观察分析,分别给与相应的个体化的心理辅助治疗方案.结果:在了解机械通气患者的心理特点、心理动态及提高医护人员的诊疗水平,给患者个性化的护理,制定有效的诊疗计划,对保持患者良好的心理状态,促进早日康复是很有意义的.结论:心理辅助治疗是对于机械通气患者有重要作用     

Fractal dimension rectified meter for quantification of liver fibrosis and other irregular microscopic objects

OBJECTIVE: To introduce a new mathematical method based on the principles of fractal geometry analysis that permits more realistic quantification of some of the physical (morphologic) aspects of irregular bodies appearing under microscopy. STUDY DESIGN: The principles of the method were tested on microscopic images of irregular collagen deposition in liver tissue. The method uses an ad hoc rectified meter implemented in a computer-assisted planar image analysis system that has been adapted to give metric measures of irregular outlines and surfaces that can be used to produce an index capable of quantifying the typical wrinkledness of biologic objects. Prototypical example measures of liver fibrosis were made on biopsy specimens showing chronic hepatitis C virus-related disease. Measurements were also made of the microscopic images of the abnormal deposition of lipid droplets in hepatocytes, a case of amyloid deposition in an osteoarthromuscular structure and a cytologic specimen of human dendritic cells. RESULTS: The proposed computer-aided method permits rapid measurements of the image of a whole biopsy section digitized at high magnification. The snapshot measurement of liver fibrosis deposition offered by a biopsy pattern is a valid means of more rigorously identifying the staging of the process. CONCLUSION: This method can measure liver fibrosis during chronic liver disease as well as any other irregular biologic structure that cannot be correctly quantified using traditional Euclidean-based metric methodologies.     

Semi-continuous and continuous riboflavin production by calcium-alginate-immobilized Candida tropicalis in concentrated rectified grape must

Candida tropicalis cells were immobilized in calcium alginate. Gel beads were used to inoculate a medium containing concentrated rectified grape must as the sole carbohydrate source for both semi-continuous and continuous riboflavin production, in a 1litre glass stirred-tank fermenter. In semi-continuous mode, vitamin B₂ concentrations in culture broth ranged from approximately 350 to 650mg.l^-1 in successive runs. In continuous mode, concentrations of about 400–600mg.l^-1 were observed in the effluent for more than 1monthwithout significant loss of flavinogenic activity. The highest value of both vitamin B₂ production and sugar bioconversion occurred at the lowest dilution rate (0.008h^-1).     

Video microscopy of colloidal gold particles and immuno-gold labelled microtubules in improved rectified DIC and epi-illumination

Modification of rectified Nomarski differential interference contrast optics (Nikon) and the epi-illumination system (Nikon IGS-cube) improved the detection of colloidal gold particles with analog video enhanced microscopy. Immuno-gold labelled microtubules of Haemanthus endosperm are visualized at a level of detection unmatched in conventional light microscopy. Single gold, or gold silver enhanced particles in suspension viewed with the modified epi-illumination after pressure injection into cells, are well distinguished from other granular cell components. Immuno-gold has also been detected on the surface of chromosomes and the nuclear envelopes in cells during the rapid experimental disassembly of microtubules. Thus, under certain conditions tubulin in a form other than microtubules may be detected. Practical applications of this "optical stain" for non fading immuno-gold 5-40 nm markers are discussed.     

Measuring movement irregularity in the upper motor neurone syndrome using normalised average rectified jerk.

Movement irregularity is a feature of the upper motor neurone (UMN) syndrome which is difficult to measure. Average rectified jerk (ARJ) has been proposed as a measure of this movement irregularity, but ARJ depends upon the duration of movement. Since movements may be slower in UMN patients, duration dependence compromises ARJ as a measure of irregularity. A normalisation technique is proposed that generates a measure of movement irregularity which is independent of movement duration: normalised average rectified jerk (NARJ). This paper presents a validation of NARJ in the UMN syndrome. Nine control subjects, nine left hemiparetic stroke patients and nine right hemiparetic stroke patients were studied. Test movements comprised elbow extension/flexion in the horizontal plane; these were recorded with an electro-goniometer and accelerometer. The effectiveness of the normalisation technique has been demonstrated using trajectories of various durations; some of these were artificially generated from participants' trajectories, in order to preserve the movement profile. The variability of NARJ and ARJ have been compared in a sample of control subjects. NARJ has been criterion validated by correlation with expert subjective rating of irregularity in a heterogeneous set of trajectories. Construct validity has been tested by discrimination between movements of control subjects, left hemiparetic stroke patients and right hemiparetic stroke patients. When comparing trajectories of identical profile but two-fold difference in movement duration, NARJ differed only 2.6% whereas ARJ differed 706%. NARJ was less reproducible in healthy participants than ARJ: median non-parametric coefficients of variation for repeated movements were 55% and 41%, respectively. Spearman rank correlation coefficient for NARJ and expert rating was 0.92 (p<0.01). NARJ measurements on right hemiparetic patients differ significantly from those made on the control group (p<0.02); corresponding ARJ measurements do not attain statistical significance. NARJ is a valid measure of movement irregularity in the UMN syndrome.     

Internal Medicine: Ventilator Management of Severe Asthma

The Scientific Board of the California Medical Association presents the following inventory of items of progress in internal medicine. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, or scholars to stay abreast of these items of progress in internal medicine that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another.The items of progress listed below were selected by the Advisory Panel to the Section on Internal Medicine of the California Medical Association, and the summaries were prepared under its direction.