静脉注射钆喷酸葡胺增强改善MRCP图像质量研究

目的：评价静脉注射钆喷酸葡胺（Gd-DTPA）增强在改善磁共振胰胆管成像（MRCP）图像质量的作用。方法：选择临床疑有胰胆管病变并准备行MRI检查患者31例作为研究对象，所有患者分别行Gd-DTPA增强前及增强后1．5min、5-10min、10．15min MRCP扫描。测量并比较增强前后MRCP图像上肝脏、胰腺、胆总管、胰管的信噪比（SNR）以及胆总管与肝实质、胰管与胰腺的信号强度比（SIR）。结果：静脉注射Gd-DTPA增强后1-5min、5．10min及10．15min图像上胰胆管树各解割结构显示情况和平均等级分数均无统计学差异（P〉0．05）；Gd-DTPA增强后的MRCP图像胰胆管树解剖结构显示情况和平均等级分数与增强前比较差异有显著性（P〈0．001）。Gd-DTPA增强后MRCP图像上来自肠系膜上静脉及其分支与胰管重叠的血管信号、左右门静脉及其分支与肝内二级胆管重叠的血管信号被明显抑制。肝脏及胰腺信号强度降低，胰胆管树对比度提高，肝内2级胆管、肝总管、胆总管和胰管显示更加清楚。结论：MRCP成像中，静脉注射Gd-DTPA增强能抑制来自左右门静脉和肠系膜上静脉及其分支等血管的高信号，提高胰胆管树的对比度，明显改善MRCP图像质量。[著者文摘]     

Predictors of educational outcomes of undergraduate nursing students in alcohol and drug education

This paper reports a study which aimed to evaluate the impact of an educational programme on alcohol and drug on knowledge acquisition, changes in attitude and intervention confidence skills of undergraduate nursing students and identify the influence of selected demographic variables on educational outcomes. Despite the high levels of morbidity and mortality resulting from substance misuse, few nurses have been adequately prepared to respond effectively. There remains a dearth of evidence on the educational interventions in alcohol and drug with undergraduate nursing students and this study intends to add a body of knowledge to this field. A quasi-experimental, pre-post-test design was used using with a purposive sample of four cohorts of undergraduate nursing students (n=110) in England. Pre-tests and post-tests after the educational intervention on alcohol and drug were administered to measure the educational outcomes. The data was collected between March 2002 and September 2003. The results showed the educational intervention on alcohol and drug had a significant impact on educational outcomes. There were significant differences between the pre-test and post-test knowledge mean score (t=-.4.61, d.f.=109, p=0.000), attitude (t=-2.36, d.f.=109, p=0.02) and intervention confidence skills (t=-9.75, d.f.=109, p=0.000). Within the multi-layered hypothesis, the results indicate that only ethnicity was found to have a significant influence on both knowledge acquisition (F(2,106)=6.59, p=0.002) and intervention confidence skills (F(2,106)=15.0, p=0.000). The study provides some evidence that a short intensive educational programme on alcohol and drug can be effective in improving educational outcomes. Further research should be undertaken with undergraduate nurses specialising in different branch of nursing.     

铜陵市部分医院细菌耐药性监测与分析

Objective To investigate the bacterial resistance of clinical isolates collected in Tongling area.Methods The clinical isolates were collected in Tongling area from Jananuary to December in 2007.Antimicrobial susceptibility test were conducted by Kirby-Bauer method.Results Of 1375 clinical isolates,399 strains(29.0%)were gram positive bacteria,and 976 strains(71.0%)were gram negative bacteria.Methicillin resistant staphylococcus aureus(MRSA)accounted for 18.4% of staphylococcus aureus,while methicillin resistant coagulase negative staphylococci(MRCNS)were 70.0% of coagulase negative staphylococci(CNS)respectively.MRSA and MRCNS were highly resistant to gentamicin,ciprofloxacin,clindamycin and erythromycin;but displayed lower resistance to rifampicin,chloramphenicol and nitrofurantion.No vancomycin-resistant staphylococcus strain was found.The resistance rates of Enterococcus faecalis were relatively low to penicillin,ampicillin,nitro furantion,fosfomycin and chloramphenicol.No vancomycin or teicoplanin-resistant enterococcus faecalis was isolated.The resistance rates of E.faecium were lower to fosfomycin and chloramphenicol.Two strains of vancomycin-resistant E.faecium were identified.About of 49.3% of E.coli and 35.9% of Klebsiella isolates produced extended-spectrum β-lactamases(ESBLs).The resistance rates of ESBLs-producing strains to 20 antimicrobial agents were much higher than those of ESBLs nonproducing ones.No imipenem or meropenem-resistant isolate was found.The resistance rate of non-fermenters was lower to imipenem,meropenem,cefoperazone-sulbactam,piperacillin-tazobactam,ceftazidime,cefepime,amikacin or ciprofloxacin.Conclusion The resistance rate of gram positive bacteria is lower to glycopeptides.The resistance rate of gram negative bacilli is lower to imipenem,meropenem,cefoperazone-sulbactam,and piperacillin-tazobactam.Surveillance of bacterial resistance is of great importance for rational use of antibiotics and reducing the emergence of resistance.     

洗胃对猪百草枯灌胃模型的清除效果分析

目的 评价不同时间点洗胃(gastric lavage,GL)清除猪胃内百草枯(paraquat,PQ)的效果,以及对血浆PQ浓度的影响.方法 将17头健康雌性家猪按随机数字表法分为PQ组(n=6)、PQ+1 h GL组(n=6)、PQ+6 h GL组(n=5).所有动物按60 mg/kg经胃管注入40％ PQ原液,PQ+1 h GL组和PQ+6 h GL组分别在1h和6h经胃管给予20 L温水单次洗胃,监测生命体征及血药浓度并持续观察24h,LC-MS法测量血浆及HPLC法测量胃洗出液中的百草枯浓度.结果 PQ组、PQ+6 h GL组和PQ +1 h GL组的24 h存活率分别为66.7％、80％、100％;血PQ峰浓度(μg/mL)分别为(5.12±3.38)、(3.99 ± 1.24)、(1.96±1.83);PQ+1hGL组和PQ+6 hGL组洗出液的PQ含量占总摄入量的(24.46±6.49)％vs.(30.72±9.86)％ (P＞0.05);前10 L和后10 L的洗出液中PQ的清除比例:PQ+1 h GL组为(20.44±5.59)％vs.(4.02±1.82)％(P＜0.01),PQ+6 h GL组为(26.17±7.19)％vs.(7.03±4.29)％(P＜0.01).结论 1h和6h洗胃均能有效清除PQ,减少24h病死率;尽早洗胃(1 h)能更明显降低血浆PQ峰浓度;洗胃液在后1/2体积(后10 L洗出液)时清除百草枯的能力明显下降.     

Feasibility of abdominal plain film images in evaluation suspected drug smuggler

Objective

Drug smuggling in the gastrointestinal tract has soared within the last 20 years. Though illegal substances in the gastrointestinal tract can be visualized with ultrasound, MRI and CT, the abdominal radiograph has by far remained the most frequently used way of detecting smuggled drugs. The purpose of the study was to evaluate the inter-radiologist interpretation error and the reliability of the abdominal radiograph in detecting smuggled drugs.

Materials and methods

A total of 279 abdominal radiographs of suspected smugglers were classified by three radiologists as clearly positive or negative for drug smuggling. All available information about the cases was collected from the customs officers and police.

Results

Out of these cases 203 (73%) were interpreted as negative and 35 (13%) as positive by all three radiologists. In 86% of the cases there was, therefore, an inter-radiological agreement in interpreting the images. In 41 (14%) cases, however, there was an inter-radiologist disagreement. Kappa-value for inter-observer variability was 0.70.

Conclusions

In up to a seventh of the abdominal radiographs the interpretation can be challenging even for an experienced radiologist. False positive interpretation can lead to innocent passengers being detained in vain. As negatively interpreted images usually result in releasing of the suspect, there is no way of knowing how many false negative occur. This makes the abdominal radiograph a suboptimal examination, and low dose CT should be considered as the screening modality for gastrointestinal drug smugglers.     

Ciprofloxacin therapy for typhoid fever needs reconsideration

Outbreaks of multidrug-resistant Salmonella enterica serotype Typhi in the Indian subcontinent in the late 1980s resulted in the failure of conventional drugs, and ciprofloxacin became the firstline drug to treat enteric fever. However, reduced susceptibility to ciprofloxacin, reported widely since 1994, has posed a therapeutic difficulty. The aim of the present work was to review the situation of drug resistance among S. enterica serotype Typhi in central India from 1988 to 2005. A minimum inhibitory concentration (MIC) study for ciprofloxacin was carried out by the agar dilution method on 314 stock cultures preserved since 1988. The MIC for ciprofloxacin was ≤0.125 mg/l for the 50 isolates isolated during 1989–1994, but during 1998–1999, 60% of the 50 isolates showed MIC > 0.125 mg/l, while in 2002–2003, 82.5 % of the 97 isolates had MIC > 0.125 mg/l and 35% had MIC > 1 mg/l (high-level resistance). In 2004–2005, 88.2% of the 77 isolates had MIC > 0.125 mg/l and 15% had MIC > 1 mg/l (high-level resistance). Sixty-four isolates showing MIC > 1 mg/l with the agar dilution method were also checked by Epsilometer test (E-test, AB Biodisk, Solna, Sweden). Based on the data, it is suggested to withdraw ciprofloxacin as a therapeutic agent for enteric fever. Fortunately, multiple drug resistance, with concurrent resistance to chloramphenicol, cotrimoxazole, and ampicillin, which had reached more than 90% in 1990–1991, started declining over the years and was as low as 5.6% in 2004–2005. According to these observations, older drugs such as chloramphenicol, cotrimoxazole, and ampicillin could be recalled to treat enteric fever.     

头孢吡肟等抗生素对革兰阴性杆菌体外敏感性连续四年耐药性监测分析

目的监测和了解头孢吡肟对临床常见革兰阴性菌体外抗菌活性。方法从1999～2002年收集的临床常见革兰阴性杆菌50528株(主要为尿液、痰、伤口及其分泌物标本)，连续监测4年。药物敏感性试验采用纸片扩散法，WHONET5软件进行结果分析。结果1999～2002年头孢吡肟对肠杆菌科细菌的敏感性为70．0％-95．2％；对铜绿假单胞菌敏感性为73．9％-77．5％。1999-2002年肠杆菌科细菌临床分离株对头孢噻肟、头孢他啶和头孢吡肟耐药性变迁的比较表明，头孢吡肟耐药率增加幅度低于头孢噻肟、头孢他啶；铜绿假单胞菌对头孢吡肟耐药率增加幅度明显低于哌拉西林、阿米卡星和头孢他啶。结论头孢吡肟对大肠埃希菌、肺炎克雷伯菌、弗劳地枸橼酸杆菌、产气肠杆菌、阴沟肠杆菌、奇异变形杆菌、铜绿假单胞菌和鲍曼不动杆菌有较好的体外抗菌活性。     

CpG oligodeoxynucleotide-loaded PAMAM dendrimer-coated magnetic nanoparticles promote apoptosis in breast cancer cells

One major application of nanotechnology in cancer treatment involves designing nanoparticles to deliver drugs, oligonucleotides, and genes to cancer cells. Nanoparticles should be engineered so that they could target and destroy tumor cells with minimal damage to healthy tissues. This research aims to develop an appropriate and efficient nanocarrier, having the ability of interacting with and delivering CpG-oligodeoxynucleotides (CpG-ODNs) to tumor cells. CpG-ODNs activate Toll-like receptor 9 (TLR9), which can generate a signal cascade for cell death. In our study, we utilized three-layer magnetic nanoparticles composed of a Fe₃O₄ magnetic core, an aminosilane (APTS) interlayer and a cationic poly(amidoamine) (PAMAM) dendrimer. This will be a novel targeted delivery system to enhance the accumulation of CpG-ODN molecules in tumor cells. The validation of CpG-ODN binding to DcMNPs was performed using agarose gel electrophoresis, UV-spectrophotometer, XPS analyses. Cytotoxicity of conjugates was assessed in MDA-MB231 and SKBR3 cancer cells based on cell viability by XTT assay and flow cytometric analysis. Our results indicated that the synthesized DcMNPs having high positive charges on their surface could attach to CpG-ODN molecules via electrostatic means. These nanoparticles with the average sizes of 40 ± 10 nm bind to CpG-ODN molecules efficiently and induce cell death in MDA-MB231 and SKBR3 tumor cells and could be considered a suitable targeted delivery system for CpG-ODN in biomedical applications. The magnetic core of these nanoparticles represents a promising option for selective drug targeting as they can be concentrated and held in position by means of an external magnetic field.     

慢性肝病合并细菌感染患者的细菌学及药物敏感状态的分析

目的 分析慢性肝病合并细菌感染患者感染的细菌种类和药物敏感状态。方法 122例住院病人感染标本的细菌分离及药敏测定。结果 共分离出细菌134株，其中G^ 茵53株，G^-菌59株，其他茵22株。根据MIC测定，氨基糖甙类和第三代头孢菌素对细菌敏感率较高，半合成青霉素敏感率较低。结论 目前慢性肝病合并感染中，细菌种类和耐药性已发生了较大变化。