Rapid detection of enterobacteriaceae producing extended spectrum beta-lactamases directly from positive blood cultures by matrix-assisted laser desorption ionization-time of flight mass spectrometry

Bacteria that produce extended-spectrum β-lactamases (ESBLs) are an increasing healthcare problem and their rapid detection is a challenge that must be overcome in order to optimize antimicrobial treatment and patient care. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS) has been used to determine resistance to β-lactams, including carbapenems in Enterobacteriaceae, but the methodology has not been fully validated as it remains time-consuming. We aimed to assess whether MALDI-TOF can be used to detect ESBL-producing Enterobacteriaceae from positive blood culture bottles in clinical practice. In the assay, 141 blood cultures were tested, 13 of them were real bacteraemias and 128 corresponded to blood culture bottles seeded with bacterial clinical isolates. Bacteraemias were analysed by MALDI-TOF after a positive growth result and the 128 remaining blood cultures 24 h after the bacterial seeding. β-lactamase activity was determined through the profile of peaks associated with the antibiotics cefotaxime and ceftazidime and its hydrolyzed forms. Clavulanic acid was added to rule out the presence of non-ESBL mechanisms. Overall data show a 99% (103 out of 104) sensitivity in detecting ESBL in positive blood cultures. Data were obtained in 90 min (maximum 150 min). The proposed methodology has a great impact on the early detection of ESBL-producing Enterobacteriaceae from positive blood cultures, being a rapid and efficient method and allowing early administration of an appropriate antibiotic therapy.     

Good results for early treatment of clinically isolated syndrome prior to multiple sclerosis with interferon beta-1b and glatiramer group

The first sign of developing multiple sclerosis is a clinically isolated syndrome that resembles a multiple sclerosis relapse. Objective/methods: The objective was to review the clinical trials of two medicines in clinically isolated syndromes (interferon β and glatiramer acetate) to determine whether they prevent progression to definite multiple sclerosis. In the BENEFIT trial, after 2 years, 45% of subjects in the placebo group developed clinically definite multiple sclerosis; the rate was lower in the interferon β-1b group. All subjects were then offered interferon β-1b, and the original interferon β-1b group became the early-treatment group and the placebo group became the delayed-treatment group. After 5 years, the number of subjects with clinical definite multiple sclerosis remained lower in the early-treatment than in the late-treatment group. In the PreCISe trial, after 2 years, the time for 25% of the subjects to convert to definite multiple sclerosis was prolonged in the glatiramer group. Interferon β-1b and glatiramer acetate slow the progression of clinically isolated syndromes to definite multiple sclerosis. However, it is not known whether this early treatment slows the progression to the physical disabilities experienced in multiple sclerosis.     

认知行为疗法在强迫症患者中的应用效果观察

目的探讨认知行为疗法在强迫症患者中的应用效果。方法选择强迫症患者52例,随机均分为A组和B组,每组各26例,两组患者给予常规护理,在此基础上B组患者实施认知行为疗法。在就诊时及治疗后(治疗第4周和第8周),采用耶鲁布朗强迫症状量表(Y-BOCS)对两组患者进行测评。结果治疗第4周和第8周,两组患者Y-BOCS总评分比较,均P<0.05,差异具有统计学意义。结论在强迫症患者的治疗过程中,实施认知行为疗法,可提高临床疗效,促进疾病的康复。     

The Aldo-Keto Reductase Superfamily and its Role in Drug Metabolism and Detoxification

The aldo-keto reductase (AKR) superfamily comprises enzymes that catalyze redox transformations involved in biosynthesis, intermediary metabolism, and detoxification. Substrates of AKRs include glucose, steroids, glycosylation end-products, lipid peroxidation products, and environmental pollutants. These proteins adopt a (β /α )₈ barrel structural motif interrupted by a number of extraneous loops and helixes that vary between proteins and bring structural identity to individual families. The human AKR family differs from the rodent families. Due to their broad substrate specificity, AKRs play an important role in the phase II detoxification of a large number of pharmaceuticals, drugs, and xenobiotics.     

血栓性血小板减少性紫癜误诊1例

患者，女，19岁，因“发热、腹泻3d，伴牙龈出血、右肩右髋部出血点1d”，至我院急诊就诊。患者入院前3d无明显诱因出现腹泻、呕吐、高热、腹痛，腹泻初为水样便，量多，后逐渐为黑色便，发热体温最高达40℃。在家自服去痛片、阿莫西林、安乃近等药。入院前1d出现牙龈出血，伴右肩、右髋部出血点。来诊时急查化验示血常规：     

ICU机械通气患者意外拔管的原因分析及对策

对2008年1月至2010年6月,在ICU发生意外拔管的16例气管插管病人的临床资料进行了总结分析。结果导致意外拔管的相关因素有:缺乏有效的固定、未使用镇静剂、未使用适当的肢体约束及护患沟通不良等。因此,对人工气道的患者应高度重视,重在预防,做到正确固定,充分沟通,适当镇静和肢体约束,是有效的护理措施。     

电话网络心电模式在社区基础医疗的应用

目的:探讨电话网络心电模式在社区基础医疗的应用效果。方法:对社区医院的142例有心脏不适症状而普通心电图多次检查均正常的患者进行电话网络心电监测(TTM)1056次,通过电话和网络传送心电信息至本院心脏监测中心,专职人员分析、诊断和出具报告,指导患者用药和治疗。结果:142例患者中发现早期心肌梗死心电图改变者1例,缺血型ST-T改变者16例,阵发性室上速22例,阵发性房颤12例,间歇性预激综合症8例,房性早搏和(或)室性早搏35例,6例安装永久起搏器和14例冠状动脉支架置入(PCI)术后患者TTM监测无新的异常出现,28例未见异常。结论:TTM监测能及时将平时心电图、Holter等难以捕捉的心电信息记录下来,为临床诊断和治疗提供有效依据,为患者提供早期诊断心脏病的检查手段。     

民国中西药学汇通代表作《汉药新觉》考略

郭若定《汉药新觉》为民国时期中西药学汇通的代表作,其上集曾被民国时期北平杂志《明日医药》连载,并刊有单行本.续集内容由其家属收藏,全书完整本于2010年由上海科学技术文献出版社出版,载药208种,以单味中药为主,并收部分复方药及西药.该书中西药学汇通思想,体现在3个方面：中西药物,兼收并蓄;衷中参西,继承创新;中西合参,旨在汇通.     

Synthesis and bioassay of β-（1,4）-D-mannans as potential agents against Alzheimer＇s disease

Aim： Oligomannurarate 971 derived from a marine plant has shown neuroprotective effects. In this study we synthesized a series of truncated derivatives of the oligosaccharide, and investigated the effect of these derivatives against Aβ peptide toxicity in vitro. Methods： The sulfoxide method was applied to synthesize the derivatives. SH-SY5Y human neuroblastoma cells were treated with Aβ1-40 （2 pmol/L）, and the cell viability was detected using a CCK8 assay. Results： A series of β-（1,4）-D-mannosyl oligosaccharide, ranging from the disaccharide to the hexasaccharide, were synthesized. Addition of 10 pmol/L β-（1,4）-D-mannobiose 6, β-（1,4）-D-mannotriose 9 or β-（1,4）-D-mannotetraose 12 in SH-SY5Y cells significantly attenuated Aβ1-40-induced toxicity. The efficacies were similar to those caused by 10 pmol/L oligomannurarate 971 or alzhemed. Other oligosaccharides including oligomaltoses and oligocelluloses were less active. Conclusion： Synthetic homogeneous short chain β-（1,4）-D-mannans shows neuroprotective effect against Aβ peptide toxicity similar to that of heterogeneous oligomannurarate 971 and alzhemed.     

英国成人护理荣誉学士培养方案简介与启示

以英国德蒙福特大学成人护理荣誉学士培养为例,介绍英国成人护理荣誉学士招生、培养方案、教学模块设置等内容。以期从中得到启示,为我国护理教育改革和专业人才的培养提供参考。