血流感染肺炎克雷伯菌中CRISPR-Cas系统的分布及其与毒力基因和耐药的关系

的 了解血流感染肺炎克雷伯菌中CRISPR-Cas系统的分布特征并分析其与毒力基因和耐药的关系。方法 收集非重复血流感染肺炎克雷伯菌248株，使用Vitek2-Compact全自动微生物分析系统进行菌株鉴定及药物敏感性分析，PCR检测CRISPR-Cas系统3个相关基因(CRISPR1、CRISPR2和cas1)、筛查6种常见高毒力荚膜血清型(K1、K2、K5、 K20、K54和K57)、12种毒力基因及检测13种耐药基因，用χ2检验比较携带有CRISPR-Cas系统菌株与不携带CRISPR-Cas系统菌株毒力及耐药差异。结果 CRISPR-Cas系统的检出率为29.8%(74/248)；K1型是携带CRISPR-Cas系统肺炎克雷伯菌的主要荚膜血清型，占 28.4%(21/74)；除kpn基因外，携带CRISPR-Cas系统菌株的毒力基因检出率均大于不携带CRISPR-Cas系统菌株，其中7种差异有统计学意义；除对氨苄西林耐药率达100%外，携带有CRISPR-Cas系统菌株的其他抗菌药物耐药率均小于不携带有CRISPR-Cas系统菌株，其中13种差异有统计学意义；携带CRISPR-Cas系统菌株的耐药基因阳性率小于不携带CRISPR-Cas系统的菌株，且blaKPC、blaSHV、qnrS基因差异有统计学意义。结论 高毒力荚膜血清型肺炎克雷伯菌中主要为K1型携带CRISPR-Cas系统，携带CRISPR-Cas系统的肺炎克雷伯菌相对于不携带CRISPR-Cas系统菌株的毒力基因阳性率高，耐药率低，耐药基因的阳性率低。CRISPR-Cas系统可能能降低耐药基因在肺炎克雷伯菌中的水平传播，尤其是在K1型肺炎克雷伯菌。     

黏菌素静脉联合雾化吸入治疗呼吸机相关性肺炎安全性与有效性的Meta分析

目的 循证评价黏菌素静脉联合雾化吸入治疗VAP 的有效性与安全性。方法 检索时间从建库截止至2018 年 3 月。计算机检索数据库：Pubmed、Embase (Ovid)、Cochrane library (2018 年3 期)， 中国知网(China National Knowledge Infrastructure, CNKI)、维普数据库(VIP Database for Chinese Technical Periodicals, VIP)、万方数据库(Wan Fang Data)，中国生物 医学文献数据库(Chinese Biomedical Literature Database, CBM)，收集关于黏菌素静脉联合吸入治疗VAP 的临床对照研究。采用 Mircosoft Excel、RevMan 5.3 进行数据分析。结果 有效性方面：①临床治愈率：静脉联合雾化吸入组总有效率显著增加[RR=1.23, 95%CI (1.07,1.41), P=0.003]；②微生物根除率：两组患者微生物根除率差异无统计学意义[RR=1.07, 95%CI(0.92,1.24), P=0.38]；③ 死亡率：相比对照组，试验组死亡率虽降低，但差异无统计学意义[RR=0.93, 95%CI(0.79,1.09), P=0.37]。安全性方面：①急性肾 损伤发生率：两组患者发生急性肾损伤的风险无明显差异(P=0.97)。结论 由此可知，IV+AS 联合方案在VAP 治疗过程中有一 定优势，但在降低死亡率、减少急性肾损伤的发生及根除微生物方面无显著差异，鉴于本研究的局限性，该结论尚待进一步验证。     

Aligning Developmental and Processing Accounts of Implicit and Statistical Learning

A long‐standing question in child language research concerns how children achieve mature syntactic knowledge in the face of a complex linguistic environment. A widely accepted view is that this process involves extracting distributional regularities from the environment in a manner that is incidental and happens, for the most part, without the learner's awareness. In this way, the debate speaks to two associated but separate literatures in language acquisition: statistical learning and implicit learning. Both fields have explored this issue in some depth but, at present, neither the results from the infant studies used by the statistical learning literature nor the artificial grammar learning tasks studies from the implicit learning literature can be used to fully explain how children's syntax becomes adult‐like. In this work, we consider an alternative explanation—that children use error‐based learning to become mature syntax users. We discuss this proposal in the light of the behavioral findings from structural priming studies and the computational findings from Chang, Dell, and Bock's (2006) dual‐path model, which incorporates properties from both statistical and implicit learning, and offers an explanation for syntax learning and structural priming using a common error‐based learning mechanism. We then turn our attention to future directions for the field, here suggesting how structural priming might inform the statistical learning and implicit learning literature on the nature of the learning mechanism.     

Bayesian adaptive lasso for additive hazard regression with current status data

Variable selection is a crucial issue in model building and it has received considerable attention in the literature of survival analysis. However, available approaches in this direction have mainly focused on time-to-event data with right censoring. Moreover, a majority of existing variable selection procedures for survival models are developed in a frequentist framework. In this article, we consider additive hazards model in the presence of current status data. We propose a Bayesian adaptive least absolute shrinkage and selection operator procedure to conduct a simultaneous variable selection and parameter estimation. Efficient Markov chain Monte Carlo methods are developed to implement posterior sampling and inference. The empirical performance of the proposed method is demonstrated by simulation studies. An application to a study on the risk factors of heart failure disease for type 2 diabetes patients is presented.     

Alterations in Carotid Parameters in ApoE–/– Mice Treated with a High-Fat Diet: A Micro-ultrasound Analysis

Information on the common carotid artery and cerebral microcirculation can be obtained by micro-ultrasound (µUS). The aim of the study described here was to investigate high-fat diet-induced alterations in vascular parameters in ApoE–/– mice. Twenty-two ApoE–/– male mice were examined by µUS and divided into the standard diet (ApoE–/–_SD) and high-fat diet (ApoE–/–_HF) groups. The µUS examination was repeated after 4 mo (T₁). Carotid stiffness, reflection magnitude and reflection index were measured; the amplitudes of the first (W₁) and second (W₂) local maxima, the local minimum (W_b) and the reflection index (RI_WIA?=?W_b/W₁) were assessed with wave intensity analysis. At T₁, ApoE–/–_HF mice had increased carotid stiffness (1.48 [0.36] vs. 1.88 [0.51]) and reflection magnitude (0.89 [0.07] vs. 0.94 [0.07]) values. Longitudinal comparisons highlighted increases in carotid stiffness for ApoE–/–_HF mice (from 1.37 [0.25] to 1.88 [0.51] m/s) but not for ApoE–/–_SD mice (from 1.40 [0.62] to 1.48 [0.36] m/s). ApoE–/–_HF mice exhibited carotid artery stiffening and increased wave reflections.     

Can muscle weakness and disability influence the relationship between pain catastrophizing and pain worsening in patients with knee osteoarthritis? A cross-sectional study

ObjectiveTo verify if the relationship between pain catastrophizing and pain worsening would be mediated by muscle weakness and disability in patients with symptomatic knee osteoarthritis.MethodsThis was a cross-sectional study in a hospital out-patient setting. Convenience sampling was used with a total of 50 participants with symptomatic knee osteoarthritis. Pain and the activities of daily livings (ADL) were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale. Pain catastrophizing was assessed using the Coping Strategy Questionnaire (CSQ) subscale. Muscle strength of knee extension and 30-s chair stand test (30CST) were also assessed. Path analysis was performed to test the hypothetical model. Goodness of fit of models were assessed by using statistical parameters such as the chi-square value, goodness of fit index (GFI), adjusted goodness of fit index (AGFI), comparative fit index (CFI), and root mean square error of approximation (RMSEA).ResultsThe chi-square values were not significant (chi-square = 0.283, p = 0.594), and the indices of goodness of fit were high, implying a valid model (GFI = 1.000; AGFI = 0.997; CFI = 1.000; RMSEA = 0.000). Pain was influenced significantly by muscle strength and ADL; muscle strength was influenced significantly by ADL via 30CST; ADL was influenced by pain catastrophizing.ConclusionThe relationship between pain catastrophizing with pain worsening are mediated by muscle weakness and disability.     

新型冠状病毒肺炎疫情下社区医院人员防控知识强化测评模式效果评价

目的 对社区医院人员防控知识强化测评模式的实施效果进行评价。方法 通过第三方数据收集平台,在规定时间内、实名制进行疫情防控知识问卷考核,以各岗位合格分数为标准,确认能否上岗,防控知识反复强化,题库动态更新,使各岗位人员保持高度认知的实战状态。结果 首次测试,医院全体人员新型冠状病毒肺炎防控知识平均分为78.37,100%的人知晓用过的一次性帽子和口罩的处理;只有23.27%的知晓医疗机构预检点或分诊台物品的消毒频次。强化测评模式实施1周后,医院全体人员新型冠状病毒肺炎防控知识平均分上升至93.84。上岗情况中,培训3 d上岗人数由48人上升至78人,培训第10天为149人,上岗率也由30.19%上升至第3天的49.05%,以及培训第10天的93.71%。结论 强制社区医院人员学习新型冠状病毒肺炎防控知识效果明显,整体水平短期内迅速提升,并保持高度认知,该强化测评模式对一线社区医院人员防控能力的提升有实际应用价值。