Correlation between the sulfamethoxazole-trimethoprim resistance of Shigella flexneri and the sul genes

The aim of this study was to discuss the correlation between the sulfamethoxazole-trimethoprim resistance of Shigella flexneri (S. flexneri) and the antibiotic resistance genes sul1, sul2, and sul3 and SXT element.From May 2013 to October 2018, 102 isolates of S. flexneri were collected from the clinical samples in Jinan. The Kirby–Bauer (K-B) test was employed to determine the antibiotic susceptibility of the S. flexneri isolates. The antibiotic resistance rate was analyzed with the WHONET5.4 software. The isolates were subject to the PCR amplification of the sul genes (sul1, sul2, and sul3) and the SXT element. On the basis of the sequencing results, the correlation between the sulfamethoxazole-trimethoprim resistance of the S. flexneri isolates and the sul genes was analyzed.The antibiotic resistance rates of the 102 S. flexneri isolates to ampicillin, streptomycin, chloramphenicol, tetracycline, and sulfamethoxazole-trimethoprim were 90.2%, 90.2%, 88.2%, 88.2%, and 62.7%, respectively. The antibiotic resistance rates of these isolates to cefotaxime, ceftazidime, and ciprofloxacin varied between 20% and 35%. However, these isolates were 100% susceptible to cefoxitin. Positive fragments were amplified from 59.8% (61/102) of the 102 S. flexneri isolates, the sizes of the sul1 and sul2 genes being 338 bp and 286 bp, respectively. The sequence alignment revealed the presence of the sul1 and sul2 genes encoding for dihydrofolate synthase. The carrying rate of the sul1 gene was 13.7% (14/102), and that of the sul2 gene was 48.0% (49/102). No target gene fragments were amplified from the 3 isolates resistant to sulfamethoxazole-trimethoprim. The sul3 gene and SXT element were not amplified from any of the isolates. The testing and statistical analysis showed that the resistance of the S. flexneri isolates to sulfamethoxazole-trimethoprim correlated to the sul1 and sul2 genes.The acquired antibiotic resistance genes sul1 and sul2 were closely associated with the resistance of the 102 S. flexneri isolates to sulfamethoxazole-trimethoprim.     

以评估为基础开展安宁缓和医疗实践

安宁缓和医疗在我国刚刚起步,迫切需要结合各个地区的实际情况来开展相关实践。确认安宁缓和医疗的服务内容,有效评估患者的预期寿命、评估患者“身、心、社、灵”各方面的需求,根据不同的需求给予合适的干预,是开展安宁缓和医疗实践的关键。恰当的评估可有助于高效开展安宁缓和医疗工作。     

Serum alpha-fetoprotein and clinical outcomes in patients with advanced hepatocellular carcinoma treated with ramucirumab

Background Post hoc analyses assessed the prognostic and predictive value of baseline alpha-fetoprotein (AFP), as well as clinical outcomes by AFP response or progression, during treatment in two placebo-controlled trials (REACH, REACH-2).Methods Serum AFP was measured at baseline and every three cycles. The prognostic and predictive value of baseline AFP was assessed by Cox regression models and Subpopulation Treatment Effect Pattern Plot method. Associations between AFP (≥ 20% increase) and radiographic progression and efficacy were assessed.Results Baseline AFP was confirmed as a continuous (REACH, REACH-2; p < 0.0001) and dichotomous (≥400 vs. <400 ng/ml; REACH, p < 0.01) prognostic factor, and was predictive for ramucirumab survival benefit in REACH (p = 0.0042 continuous; p < 0.0001 dichotomous). Time to AFP (hazard ratio [HR] 0.513; p < 0.0001) and radiographic (HR 0.549; p < 0.0001) progression favoured ramucirumab. Association between AFP and radiographic progression was shown for up to 6 (odds ratio [OR] 5.1; p < 0.0001) and 6–12 weeks (OR 1.8; p = 0.0065). AFP response was higher with ramucirumab vs. placebo (p < 0.0001). Survival was longer in patients with an AFP response than patients without (13.6 vs. 5.6 months, HR 0.451; 95% confidence interval, 0.354–0.574; p < 0.0001).Conclusions AFP is an important prognostic factor and a predictive biomarker for ramucirumab survival benefit. AFP ≥ 400 ng/ml is an appropriate selection criterion for ramucirumab.Clinical Trial Registration ClinicalTrials.gov, REACH ({"type":"clinical-trial","attrs":{"text":"NCT01140347","term_id":"NCT01140347"}}NCT01140347) and REACH-2 ({"type":"clinical-trial","attrs":{"text":"NCT02435433","term_id":"NCT02435433"}}NCT02435433).Subject terms: Oncology, Biomarkers     

中医分时辨治与盐酸氟西汀比较治疗糖尿病合并抑郁症的Meta分析＊

目的 系统评价中医分时辨治糖尿病合并抑郁症的效果。方法 计算机检索中国期刊全文数据库（CNKI）、维普中文科技期刊全文数据库（VIP）、万方数据库（Wanfang Data），中国生物医学文献数据库（CBM），搜集国内有关中医分时辨治相关的随机病例对照研究，检索时限均从2010年1月1日到至2020年12月20日。由2名独立研究者对文献资料进行提取，并评价纳入研究的偏倚风险后，采用RevMan5.3软件进行研究合并Meta分析。结果 共纳入10个相关研究，包括1008名研究对象。Meta分析结果显示：与盐酸氟西汀相比较，中医分时辨治糖尿病合并抑郁症在降低汉密尔顿抑郁量表（HAMD）［MD=-0.61， 95%CI （-3.68， 2.46）， P<0.00001］与汉密尔顿焦虑量表（HAMA）［MD=-0.21， 95%CI （-3.49， 3.08）， P<0.00001］评分没有统计学意义，但对空腹血糖（FPG）［MD=-0.80， 95%CI （-0.94， -0.65）， P<0.00001］、餐后2 h血糖（2HPG）［MD=-0.74， 95%CI （-1.02， -0.46）， P<0.00001］、糖化血红蛋白（HbA1c）［MD=-0.21， 95%CI （-0.38， -0.04）， P=0.02］、总胆固醇（TG）［MD=-0.48， 95%CI （-0.61， -0.36）， P<0.00001］、总甘油三酯（TC）［MD=-0.47， 95%CI （-0.62， -0.32）， P<0.00001］水平下降明显。结论 当前的证据表明，中医分时辨治方法治疗糖尿病合并抑郁症相对于西药盐酸氟在降低抑郁症状方面没有明显优势，但在降低血糖与血脂水平方面有较高的临床价值，这可能与分时辨治的药物有关，但同时结论受研究数量和质量的影响，更多高质量临床研究仍需开展，对上述结论予以确认。     

我国高等医学院校医学人才培养体制现状调查与分析

目的  为了遵循医学人才培养规律，规范医学人才培养体制，提高医学人才培养质量，探索符合我国实际需求的医学人才培养模式。方法  采用问卷调查法对全国140所高等医学院校进行调查，并对相关调查结果进行分析。结果  ①86.96%的高校对统一规范为“5+3”一体化为主体，同时参加住院医师规范化培训，毕业合格者授予医学博士（MD）学位表示赞成。②76.80%的高校对将“5+3”一体化作为培养全科医生主要渠道的医学博士培养体系表示赞成。③90.40%的高校对通过“5+3+X”一贯制培养授予MD+PhD项目，培养复合型高水平临床医学人才表示赞成。④84.80%的高校对医学学位授予与专科医师规范化培训相脱离，后者应纳入职业培训范畴表示赞成。结论  全面推进落实“5+3”为主体的高素质临床医学相关人才培养模式，将培养目标定位为以满足社会需求的高水平全科医生为主体，加快高层次复合型医学人才的培养体系建设。