细菌耐药率及抗菌药物用药频度相关性分析

目的研究慈溪市人民医院呼吸内科2013—2015年细菌耐药率情况及抗菌药物用药频度(DDDs)间的关系,为临床合理用药提供选择依据。方法分析2013—2015年呼吸内科分离出的主要病原菌的耐药率及DDDs情况,采用SPSS.16.0统计软件分析其相关性。结果呼吸内科分离出的病原菌株数量最高的前5名为:嗜麦芽寡养单胞菌、鲍曼不动杆菌、阴沟肠杆菌、金黄色葡萄球菌,热带假丝酵母菌。DDDs值最高的前5名为左氧氟沙星、克拉霉素、头孢噻肟、哌拉西林他唑巴坦、制霉菌素。其中金黄色葡萄球菌对头孢噻肟的耐药率与其DDDs值存在相关性(r=0.99,P<0.05),其耐药率高于全院平均水平(P<0.05);阴沟肠杆菌对左氧氟沙星的耐药率与其DDDs值存在相关性(r=0.99,P<0.05),其耐药率与全院平均水平无显著性差异(P>0.05)。结论部分抗菌药物的DDDs值与细菌耐药率之间存在正相关,可作为临床选择抗生素治疗的依据之一。     

Is neck tilt and shoulder imbalance the same phenomenon? A prospective analysis of 89 adolescent idiopathic scoliosis patients (Lenke type 1 and 2)

Purpose

To introduce a new clinical neck tilt grading and to investigate clinically and radiologically whether neck tilt and shoulder imbalance is the same phenomenon in AIS patients.

Methods

89 AIS Lenke 1 and 2 cases were assessed prospectively using the new clinical neck tilt grading. Shoulder imbalance and neck tilt were correlated with coracoid height difference (CHD), clavicle\rib intersection distance (CRID), clavicle angle (CA), radiographic shoulder height (RSH), T1 tilt and cervical axis.

Results

Mean age was 17.2 ± 3.8 years old. 66.3 % were Lenke type 1 and 33.7 % were type 2 curves. Strong intraobserver (0.79) and interobserver (0.75) agreement of the clinical neck tilt grading was noted. No significant correlation was observed between clinical neck tilt and shoulder imbalance (0.936). 56.3 % of grade 3 neck tilt, 50.0 % grade 2 neck tilt patients had grade 0 shoulder imbalance. In patients with grade 2 shoulder imbalance, 42.9 % had grade 0, 35.7 % grade 1, 14.3 % grade 2 and only 7.1 % had grade 3 neck tilt. CHD, CRID, CA and RSH correlated with shoulder imbalance. T1 tilt and cervical axis measurements correlated with neck tilt.

Conclusions

In conclusion, neck tilt is distinct from shoulder imbalance. Clinical neck tilt has poor correlation with clinical shoulder imbalance. Clinical neck tilt grading correlated with cervical axis and T1 tilt whereas clinical shoulder grading correlated with CHD, RSH CRID and CA.

     

The effect of <Emphasis Type="Italic">Clostridium butyricum</Emphasis> MIYAIRI on the prevention of pouchitis and alteration of the microbiota profile in patients with ulcerative colitis

Purpose

Ulcerative colitis (UC) is a chronic, relapsing, and refractory disorder of the intestine. Total proctocolectomy with ileal pouch anal anastomosis (IPAA) is the preferred and standard surgical procedure for patients’ refractory to medical therapy. Pouchitis is one of the most common long-term complications after IPAA. In the present study, the safety and efficacy of Clostridium butyricum MIYAIRI (CBM) as a probiotic were examined.

Methods

A randomized and placebo-controlled study was performed. Seventeen patients were recruited from 2007 to 2013. Nine tablets of MIYA-BM^® or placebo were orally administered once daily. The cumulative pouchitis-free survival, pouch condition (using the modified pouch disease activity index), and blood parameters were evaluated. A fecal sample analysis was also performed.

Results

Subjects were randomly allocated to receive MIYA-BM or placebo (9 and 8 subjects, respectively). One subject in the MIYA-BM group and four subjects in the placebo group developed pouchitis. No side effects occurred in either group. Characteristic intestinal flora was observed in each group.

Conclusions

Our results suggest that probiotic therapy with CBM achieved favorable results with minimal side effects and might be a useful complementary therapy for the prevention of pouchitis in patients with UC who have undergone IPAA.

     

Haploidentical hematopoietic stem cell transplantation for paediatric high‐risk T‐cell acute lymphoblastic leukaemia

Paediatric HR T‐cell ALL demonstrates dismal prognosis with chemotherapy, and poor outcomes could be improved with allo‐SCT. HID‐SCT is an almost immediately available choice; however, few studies have focused on the outcomes of HID‐SCT for paediatric HR T‐ALL. Forty‐eight consecutive HR T‐ALL children who underwent HID‐SCT were included. Survival outcomes and factors predictive of outcomes were retrospectively analysed. Of the 48 patients, 35 were in CR1, 10 in CR2, and three in relapse. The cumulative incidence of grade 3/4 aGVHD was 10.4% and that of extensive cGVHD was 28.4%. The CIR at three yr was 30.8% and that of NRM at three yr was 14.7%. At a median follow‐up of 20.0 (range 2.5–124.2) months, the three‐yr LFS was 54.4%. Children who received transplants during CR1 had a better LFS (65.7% vs. 26.0%, p = 0.008) and a lower relapse rate (19.8% vs. 56.7%, p = 0.014) compared to those during non‐CR1. HID‐SCT is feasible for HR T‐ALL children, and survival outcomes are better when performed in CR1 compared to non‐CR1. Prospective clinical trials would be needed to confirm that.     

Fatal warm autoimmune hemolytic anemia in a child due to IgM‐type autoantibodies

Herein is described a case of immunoglobulin M (IgM) warm autoimmune hemolytic anemia (AIHA) in a child who consequently died within 3 days of clinical onset. A previously healthy 11‐year‐old boy presented with fever, anemia, jaundice, and deteriorating consciousness. On direct agglutination test against group O red blood cells, agglutination was seen even at 37°C in saline, which was abolished on dithiothreitol treatment of the serum, indicating that the responsible autoantibody was IgM and had a warm‐reactive capacity. A diagnosis of IgM warm AIHA was therefore made. Hemagglutination in the visceral capillaries was considered as the direct cause of organ dysfunction. The patient died due to respiratory failure. IgM warm AIHA is a very severe condition that is difficult to reverse in an advanced state. Both prompt, definite diagnosis and intervention are therefore vital to prevent severe multi‐organ dysfunction in cases of IgM warm AIHA.     

三维腔镜系统在腹腔镜联合胆道镜胆囊取石术中的运用

目的探讨三维腔镜系统在腹腔镜联合胆道镜胆囊取石术中的优势。方法将2015年4月至10月同济大学附属东方医院肝胆外科行二维腹腔镜联合胆道镜胆囊取石术33例患者(二维组)与同期行三维腹腔镜联合胆道镜胆囊取石术30例患者(三维组)的临床资料进行对照研究,比较两组的手术时间、胆囊缝合时间、术中出血量等有无差异。结果两组手术均成功完成,63例患者中,二维组有3例、三维组有4例中转切胆术式(P0.05),均无中转开腹患者。手术时间、胆囊缝合时间、术中出血量,二维组分别为(31.7±4.8)min、(14.2±3.0)min、(9.1±3.8)ml,三维组分别为(29.4±4.7)min、(11.7±2.4)min、(8.5±3.2)ml;两组的胆囊缝合时间比较,差异有统计学意义(P0.05),手术时间、术中出血量比较,差异无统计学意义(P0.05)。两组患者术后均随访6个月,无结石复发,无再次住院。结论三维腔镜系统在腹腔镜联合胆道镜胆囊取石术中安全、有效,在一定程度上可缩短胆囊缝合时间,提高胆囊缝合质量,降低手术难度,可作为腹腔镜联合胆道镜胆囊取石术的选择。     

磁共振扩散张量成像与纤维束成像在脊髓型颈椎病中的应用研究

目的 :评价磁共振扩散张量成像技术(diffusion tensor imaging,DTI)对脊髓型颈椎病的诊断价值。方法 :对收集的2014年1月至2015年4月20例健康志愿者和50例脊髓型颈椎病(CSM)患者行颈髓DTI。以健康志愿者作为对照组。依据颈髓MRI平扫结果将CSM患者分A、B、C组,A组17例(单纯硬膜囊受压),B组23例(颈髓受压,信号正常),C组10例(颈髓受压,T2高信号)。分析4组颈髓的平均表观扩散系数(ADC)、平均分数各向异性值(FA)之间的差异,对所有受检者行颈髓纤维束成像。结果:对照组C_2/C_3、C_3/C_4、C_4/C_5、C_5/C_6、C_6/C_7之间ADC值及FA值差异无统计学意义(P0.05),平均ADC值为(0.875±0.096)×10~(-3)mm~2/s,平均FA值为0.720±0.051;对照组与A组比较,平均ADC值、FA值差异无统计学意义,对照组与B、C组及A、B、C组间比较,平均ADC值、FA值差异均有统计学意义。结论:颈髓DTI较常规MRI能够早期、准确地量化脊髓型颈椎病的颈髓微结构改变,颈髓纤维束成像可以反映脊髓纤维束受压损伤的范围。