临床分离耐甲氧西林表皮葡萄球菌SCCmec型别多样性分析

目的探讨临床分离耐甲氧西林表皮葡萄球菌(MRSE)SCCmec型别。方法收集临床分离并经全自动微生物鉴定系统准确鉴定的表皮葡萄球菌84株,通过PCR扩增esp和mecA基因准确鉴定MRSE,采用多重PCR对MRSE SCCmec进行分型,分析其分布特点。结果 PCR扩增结果显示,84株临床分离表皮葡萄球菌均可扩增出esp基因,mecA检出率为76.19%(64/84),其中血液、痰液、尿液和伤口分泌物MRSE检出率分别为76.8%、68.8%、100.0%和71.4%。多重PCR扩增结果显示,64株MRSE中,SCCmec单一型别为22株,其中SCCmecⅠ型19株、SCCmecⅢ型3株;SCCmec混合型为42株,其中Ⅰ、Ⅱ混合型2株,Ⅰ、Ⅲ混合型14株,Ⅰ、Ⅱ、Ⅲ混合型12株,Ⅱ、Ⅲ混合型5株,Ⅲ、Ⅳ混合型9株。结论临床分离的MRSE SCCmec型别存在明显的多样性,以混合SCCmec型别为主。     

携带psm-mec基因的耐甲氧西林表皮葡萄球菌产细菌生物膜的能力研究

目的探讨耐甲氧西林表皮葡萄球菌(MRSE)携带psm-mec基因的情况及产细菌生物膜(biofilm,Bf)的能力,为进一步分析psm-mec与Bf的关系奠定基础。方法收集临床分离并经全自动微生物鉴定系统准确鉴定的表皮葡萄球菌84株,通过PCR扩增esp和mecA基因准确鉴定和区分甲氧西林敏感表皮葡萄球菌(MSSE)和MRSE,常规PCR检测psm-mec基因确定携带psm-mec菌株,PCR扩增fudoh基因及测序检测psm-mec上游有无基因突变,96孔培养板半定量法评估菌株产Bf的能力。结果 84株表皮葡萄球菌中esp基因均阳性,mecA基因阳性64株,故MRSE为64株(76.2%)。MRSE中psm-mec基因的携带率为39.1%(25/64)。Bf半定量检测发现,25株psm-mec阳性MRSE中产Bf 20株(80%),39株psm-mec阴性MRSE中产Bf13株(33.33%),差异有统计学意义(χ2=13.28,P0.05)。fudoh基因序列分析发现,20株产Bf且携带psm-mec的MRSE均未发现基因突变,另有3株不产Bf的psm-mec阳性MRSE在psm-mec上游存在点突变(GA)。结论 psm-mec广泛存在于临床分离的MRSE中,绝大部分携带psm-mec的MRSE具有Bf形成能力。     

耐甲氧西林金黄色葡萄球菌基因分型的研究

目的 应用多重聚合酶链反应(PCR)对临床分离的耐甲氧西林金黄色葡萄球菌(Methicillin-resistant Staphylococcus aureus,MRSA)的金黄色葡萄球菌染色体mec基因盒(Staphylococcal chromosomal cassette mec,SCCmec)基因型及亚型进行分型。方法 收集该院2012年1~9月临床分离的30株耐甲氧西林金黄色葡萄球菌,用多重PCR检测MRSA的SCCmec的基因型及亚型。结果 检出SCCmecⅠ型菌株1株(3.3%),SCCmecⅠA型菌株1株(3.3%),SCCmecⅡ型菌株4株(13.3%),SCCmecⅢ型菌株23株(76.7%),SCCmecⅣ型菌株1株(3.3%)。结论 该院分离的MRSA以携带SCCmecⅢ为主。多重PCR可用于临床实验室MRSA的SCCmec基因分型。     

耐甲氧西林金黄色葡萄球菌的SCCmec检测及耐药性分析

目的探明耐甲氧西林金黄色葡萄球菌（MRSA）的流行情况,分析葡萄球菌盒染色体mec（SCCmec）的主要分型,通过检测葡萄球菌属细菌的耐药性,为MRSA的流行病学调查和临床治疗提供理论依据。方法用头孢西丁纸片法筛选耐甲氧西林的金黄色葡萄球菌,用青霉素结合蛋白2a（PBP2a）测定法对MRSA进行确证;应用实时荧光定量PCR系统扩增葡萄球菌染色体mec盒,并对MRSA进行基因分型;用VITEK 32全自动微生物分析仪检测其耐药性。结果 97株MRSA菌株中包括SCCmec II型12株、Ⅲ型77株、IV型8株。所有菌株对包括苯唑西林在内的多种抗生素耐药,对利福平的耐药率均较低,对万古霉素完全敏感,各型别间差异无统计学意义。Ⅲ型MRSA菌株表现为多重耐药,耐药率高于II型、IV型MRSA菌株。结论深圳东部地区临床分离的MRSA SCCmec基因型以Ⅲ型菌株为主,且具有对抗生素多重耐药的特征。     

耐甲氧西林金黄色葡萄球菌耐药性，SCCmec分型及毒素基因的检测

目的调查北京大学第一医院致病性耐甲氧西林金黄色葡萄球菌SCCmec分型情况、耐药状况、PVL、TSST-1基因携带率,初步了解临床耐甲氧西林金黄色葡萄球菌的耐药原因,为临床感染控制提供依据。方法收集2007年9月至2008年3月住院患者首次分离的53株有致病意义MRSA,用全自动微生物分析仪进行药敏试验,应用PCR方法检测MBSA的SCCmec基因型、PVL、TSST-1基因。结果53株MRSA呈多重耐药特点,SCCmec分型以ⅢA为主（47．2％）,PVL基因均为阴性,12株（22％）MRSA TSST-1阳性。结论53株MILSA的多重耐药性与SCCmec结构密切相关,SCCmec分型技术是探索MRSA多重耐药性与耐药结构有效的分子生物学手段,TSST-1基因阳性株在临床分离的金黄色葡萄球菌中占有较高的比例。     

医院与社区获得性耐甲氧西林金黄色葡萄球菌的分子流行病学研究

目的探讨医院与社区获得性耐甲氧西林金黄色葡萄球菌(MRSA)产生耐药的分子流行病学特征。方法采用培养法分离出MRSA,PCR法检测mecA基因并分型。结果 189株MRSA标本甲氧西林决定因子(mecA)基因检测有178株为阳性,进行mecA基因分型,SCCmecⅡ型24株,SCCmecⅢ型101株,SCCmecⅣ型51株,其他2株未能分型,分型结果存在差异。结论 MRSA以SCCmecⅢ型为主,MRSA的产生与抗菌药物的使用具有相关性。     

MRSA杀白细胞素基因检测和SCCmec分子流行病学调查

目的 了解我院临床分离的耐甲氧西林金葡菌(MRSA)葡萄球菌染色体mec基因盒(staphyloccoccal cassette chromosome mec,SCCmec)的分布和杀白细胞毒素(Panton-Valentine Leukocidin,PVL)基因的携带状况.方法 收集我院2005年10月-2006年6月从临床标本中分离的30株MRSA(mecA基因阳性).运用多重PCR检测SCCmec的基因型和亚型;PCR扩增PVL基因;纸片扩散法检测MRSA对10种抗菌药物的耐药性.结果 30株MRSA中,SCCmecⅡ型6株(20.0%);SCCmecⅢ型15株(50.0%);SCCmecⅣa型1株和SCCmecⅤ型2株.6株MecA基因阳性菌株未能分型.PVL总阳性率36.7%(11/30),其中SCCmecⅡ1株、SCCmecⅢ5株、SCCmecⅣa 1株,SCCmecⅤ2株、未分型2株.SCCmecⅡ型和SCCmecⅢ型菌株除对β内酰胺类抗生素耐药以外,对其他抗菌药物呈现多重耐药.SCCmecaⅣa和SCCmecⅤ型的菌株除对β内酰胺类抗生素耐药以外,对其他类抗菌药物均敏感.结论 我院临床分离MRSA的SCCmec型别主要以SCCmecⅢ和SCCmecⅡ为主;PVL基因的阳性率较高;携带SCCmecⅡ和SCCmecⅢ的MRSA对抗菌药物呈现多重耐药现象.     

应用多重聚合酶链反应对耐甲氧西林金黄色葡萄球菌进行SCCmec基因分型

目的应用多重聚合酶链反应（PCR）对临床分离的耐甲氧西林金黄色葡萄球菌的SCCmec基因型及亚型进行分型。方法收集本院2005年2月至7月临床分离的112株金黄色葡萄球菌，应用PCR扩增mecA基因检测MRSA，用多重PCR检测MRSA的SCCmec的基因型及亚型。用全自动微生物分析仪进行药敏试验。结果72株金黄色葡萄球菌的mecA基因阳性，确定为MRSA，阳性率为64．3％（72／112）。SCCmecⅢ和SCCmecⅢA的阳性率分别为68．1％（49／72）和20．8％（15／72），H16和H56为SCCmecⅡ，H19为SCCmecⅣ，5株MRSA没有被分型。携带SCCmecⅡ、SCCmecⅢ或SCCmecⅢA的菌株均为多重耐药株，而携带SCCmecⅣ的菌株除对B内酰胺类药物耐药外，对其他类别的抗菌素敏感。结论本院分离的MRSA以SCCmecⅢ和SCCmecⅢA为主。多重PCR对MRSA进行SCCmec基因分型结果可靠，适合临床实验室。携带SCCmecⅡ、SCCmecⅢ或SCCmecⅢA的临床分离株耐药性严重。     

多重PCR法对耐甲氧西林金黄色葡萄球菌染色体mec盒的分型研究

目的研究本院2002年连续收集的102株耐甲氧西林金黄色葡萄球菌（MRSA）染色体mec盒（SCCmec）的分型特点。方法用多重PCR法对MRSA SCCmec的结构和其变异情况进行分析及分子分型。结果102株MRSA中有94株属SCCmec-Ⅲ型，4株属SCCmec-ⅢA亚型，2株属SCCmec-Ⅳ型，2株属SCCmec-Ⅰ型。结论通过多重PCR法分型，表明SCCmec-Ⅲ型是引发本院2002年MRSA感染的主要菌型。     

多重PCR检测耐甲氧西林金黄色葡萄球菌

目的建立一种直接、快速检测耐甲氧西林金黄色葡萄球菌(MRSA)的多重PCR方法。方法设计3对引物,在同一反应管中同时扩增检测mecA、femA和IS431基因,扩增产物经凝胶成像系统分析。结果9株MRSA菌株mecA、fe-mA和IS431均阳性,5株凝固酶阴性的耐甲氧西林的葡萄球菌mecA和IS431阳性,7株甲氧西林敏感的金黄色葡萄球菌femA和IS431阳性,11株甲氧西林敏感的凝固酶阴性葡萄球菌IS431阳性,而大肠杆菌、肺炎链球菌等非葡萄球菌mecA、femA和IS431均阴性;当MRSA茵浓度达102CFU／ml时就可检出。结论通过同时扩增mecA、femA和IS431基因的多重PCR技术,能准确、快速地鉴定耐甲氧西林的金黄色葡萄球菌和凝固酶阴性的葡萄球菌。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.