新型冠状病毒肺炎中医诊疗方案用药规律数据挖掘＊

目的 基于中医传承辅助平台（V2.5），挖掘国家及省级卫生主管部门所公布的NCP中医诊疗方案的用药规律及新方挖掘。方法 收集国家及省级卫生主管部门公布的新型冠状病毒肺炎（Novel Coronavirus Pneumonia，NCP）中医诊疗方案，提取方案中四诊信息及处方用药信息，共收集到处方76首，录入中医传承辅助平台软件，建立数据库，采用软件集成的关联规则、复杂系统熵聚类核心组合分析及无监督的熵层次聚类新方分析等方法，分析NCP中医诊疗用药规律。结果 对入选的76首处方进行分析，得出本病治疗药物寒温并用，辛甘苦味为主，药物归经主要是肺、胃、脾经，常用药物有杏仁、甘草、生石膏、黄芩、麻黄、连翘、茯苓、苍术、大黄、法半夏等，并得到新处方7首。结论 NCP治疗以辛温解表、清热解毒、化湿健脾、清肺平喘为主。     

湄公河流域疾病监测网络综合监测经验及启示

介绍了湄公河流域疾病监测网络的管理机制、核心战略、数据管理及实施效果。指出要提高我国疾病预防控制系统综合监测水平，应在以下方面努力:探索建立跨境公共卫生综合监测网络和协调共享模式；建立跨区域公共卫生综合监测网络和数据共享机制；加强数据评估，提高综合监测数据质量和及时性；建立综合监测系统第三方评价机制；开发公共卫生人力资源；加强流行病学能力建设等     

儿童肺炎金黄色葡萄球菌分离株的分子生物学特征及耐药性研究

目的了解儿童金黄色葡萄球菌(金葡菌)肺炎致病株分子特征及耐药性,供临床诊治参考。方法收集2016年1月至2017年3月首都医科大学附属北京儿童医院确诊为金葡菌肺炎患者分离株,采用头孢西丁纸片法和mecA检测鉴定耐甲氧西林金葡菌(MRSA)或甲氧西林敏感金葡菌(MSSA);对所有菌株进行多位点序列分型(MLST)和葡萄球菌蛋白A(spa)分型,并对MRSA菌株进行葡萄球菌盒氏染色体(SCCmec)分型;采用PCR方法检测21种超抗原(SAgs)基因、杀白细胞素(PVL)基因、黏附基因fnbB、cna;采用琼脂稀释法、E-test检测14种抗生素体外药物敏感性。结果共收集42株金葡菌,其中MRSA、MSSA各21株。MRSA的优势克隆为ST59-SCCmecⅣa-t437(71.4%);MSSA的分型较为分散,以ST25-t078(14.2%)最多见。42株金葡菌中有36株(85.7%)至少携带1种超抗原基因,最常见的超抗原基因型为sek-seq(21.4%);MRSA pvl基因携带率(52.3%)明显高于MSSA(14.2%),而MSSA fnbB及cna基因携带率(42.8%和47.6%)明显高于MRSA(均为9.5%),差异均有统计学意义(均P<0.05)。本组金葡菌多重耐药率达90.4%(38/42株)。结论MRSA在儿童金葡菌肺炎致病株中检出率高,其主要克隆型为ST59-SCCmecⅣa-t437。儿童肺炎金葡菌分离株的超抗原基因携带率和多重耐药率较高,MRSA菌株常携带pvl基因,而MSSA菌株携带fnbB、cna更常见。     

新型冠状病毒肺炎疫情下喉镜检查的防护策略

目的探讨新型冠状病毒肺炎（COVID 19）疫情下耳鼻咽喉头颈外科喉镜室如何做好防护工作，在保证临床诊疗工作顺利完成的同时保护好医务人员及患者健康、避免院内交叉感染。方法本研究查阅相关资料并总结医院的疫情防控经验及应对策略，在患者合理分流、喉镜室工作环境的布置及工作人员的个人防护、喉镜检查前的准备工作、检查中的操作流程及注意事项及检查后的清洁消毒工作等方面做好疫情期间周详合理的工作安排。结果疫情期间，耳鼻咽喉头颈外科喉镜室每日临床工作顺利完成，所有医务人员及患者均未感染新型冠状病毒，也未出现其他院内交叉感染。结论耳鼻咽喉头颈外科喉镜室的防护策略合理有效，能够在完成临床诊疗工作的同时有效保护医患的健康。     

2019 novel coronavirus disease (COVID-19) in Taiwan: Reports of two cases from Wuhan,China

We reported two cases with community-acquired pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who returned from Wuhan, China in January, 2020. The reported cases highlight non-specific clinical presentations of 2019 novel coronavirus disease (COVID-19) as well as the importance of rapid laboratory-based diagnosis.     

Legionella longbeachae pneumonia: A case report and literature review in Japan

Herein, we report the case of a 74-year-old man diagnosed with Legionella pneumonia detected by Loop-Mediated Isothermal Amplification (LAMP) method, which was suspected to have been transmitted from the potting soil. Legionella longbeachae was identified in the sputum culture. The patient was intubated and maintained on mechanical ventilation. Antimicrobial therapy with azithromycin was also administered. His symptoms were resolved and he was discharged after 26 days of hospitalization. Legionella longbeachae pneumonia rarely occurs in Japan, and published literature of Legionella longbeachae pneumonia cases in Japan was reviewed. Patients with severe pneumonia exposed to potting soils, but with negative urinary antigen test results, should be examined by LAMP method.     

Corynebacterium species as one of the major causative pathogens of bacterial pneumonia

Recent advances using molecular methods, matrix-assisted laser desorption ionization time of flightmass spectrometry, and next-generation sequencers enable rapid and precise detection of bacterial species in the clinical samples, revealing bacterial diversities in the human body. Corynebacterium species are Gram-positive bacilli, which can cause pneumonia and have been reported as causative pathogens of lower respiratory tract infections since the 1970's. However, Corynebacterium spp. may be recognized and sorted as part of normal respiratory flora on Gram staining and culture, resulting in clinical under-recognition as pathogenic bacteria.The results of the clone library method using bacterial 16S ribosomal RNA gene sequence analysis in Japanese patients with hospital-acquired pneumonia revealed that bronchoalveolar lavage fluid obtained from the lung lesions contained 11.8% Corynebacterium spp., which was the second most predominant bacterial phylotype. Additionally, among patients in whom Corynebacterium spp. were detected, C. simulans was most commonly detected followed by C. striatum. In addition, almost half of the patients in whom C. simulans was detected was monophylotypic infection and/or co-detection of C. simulansand C. striatum. Further clinical information is expected on corynebacteria as pathogens of lower respiratory tract infection.     

Which Nursing Home Residents With Pneumonia Are Managed On-Site and Which Are Hospitalized? Results from 2 Years' Surveillance in 14 US Homes

ObjectivesPneumonia is a frequent cause of hospitalization among nursing home (NH) residents, but little information is available as to how clinical presentation and other characteristics relate to hospitalization, and the differential use of antimicrobials based on hospitalization status. This study examined how hospitalized and nonhospitalized NH residents with pneumonia differ.DesignData from a 2-year prospective study of residents who participated in a randomized controlled trial.Setting and ParticipantsAll residents from 14 NHs in North Carolina followed for pneumonia over a 2-year period.MethodsClinical features, antimicrobial treatment, hospitalization, and demographic data on residents with a pneumonia diagnosis were abstracted from charts; NH information was obtained from NH administrators.ResultsA total of 509 pneumonia episodes were reported for 395 unique residents; the incidence was not higher in the winter months, and 28% were hospitalized. The likelihood of hospitalization did not differ by clinical characteristics except that residents with a respiratory rate >25 breaths per minute were more likely to be hospitalized. Being on hospice [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.5–7.4] and not having dementia (OR 1.9, 95% CI 1.1–3.2) also related to increased likelihood of hospitalization. Fluoroquinolone (usually levofloxacin) monotherapy was the most common treatment (54%) in both settings, and ceftriaxone monotherapy varied by hospitalization status (7% of hospitalized vs 16% treated on-site). Approximately 36% of nonhospitalized residents received antimicrobials for more than 7 days.Conclusions/ImplicationsRespiratory rate is associated with hospitalization but was not documented for more than a quarter of residents, suggesting the clinical benefit of more consistently conducting this assessment. Differential hospitalization rates for persons with dementia and on hospice suggest that care is being tailored to individuals' wishes, but this assumption merits study, as does use of fluoroquinolones (due to side effects) and treatment duration (due to potential contribution to antibiotic resistance).