凝血检验标本采集与处理过程中的质量控制分析

目的观察分析凝血检验标本采集与处理过程中的质量控制。方法选择凝血检验标本采集与处理强化质控措施实施后(2018年3月至2019年2月)和实施前(2017年3月至2018年2月)在本院行凝血检验的健康体检者各41例,分别作为观察组和对照组。收集两组待检查者的标本采集、处理过程记录,比较两组标本不合格发生率。结果观察组凝血检验标本不合格发生率(2.44%,1/41)显著低于对照组(19.51%,8/41),差异有统计学意义(P<0.05)。结论强化质控措施可有效提升凝血检验标本采集与处理过程规范性,降低不合格标本风险,有助于保障凝血检验准确性和有效性,临床应用价值较高。     

Characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae and in vitro synergy of the colistin–meropenem combination

Abstract

In this prospective study, consecutive isolates of Klebsiella pneumoniae were tested for different mechanisms of carbapenem resistance using the modified Hodge test (MHT), Rosco Neo-Sensitabs (ROSCO). Phenylalanine arginine beta-naphthylamide assay (PABN) inhibitor-based test was done on isolates in which the mechanism of resistance was not identifiable by the ROSCO. Among 105 selected isolates, carbapenemase production was noted in 100 (95%) by MHT and ROSCO showed 97 (92·4%) inhibition with dipicolinic acid signifying the production of MBL. PCR amplification was positive in 90 (86%) isolates for bla_NDM-1 and 46 (44%) isolates for bla_OXA-48. 54 (51%) isolates were positive for bla_CTX-M and all belonged to bla_CTX-M group 1. Isolates co produced bla_OXA-48 (31/105, 30%) and bla_CTX-M (40/105, 38%) in combination with the carbapenemase (bla_NDM-1) gene. Five colistin-resistant isolates were positive for bla_OXA-48. Eight isolates did not show inhibition with any of the inhibitor containing disks and found to be positive for bla_OXA-48. Isolates were tested for colistin-meropenem synergy and detection rate was higher by the checkerboard (48%) than E-test method (35%). Our study necessitates continuous surveillance to recognize the predominant machinery of resistance in a particular geographical region to formulate effective control measures.     

Predicting response to IL-2 therapy for metastatic melanoma

Evaluation of: Sabatino M, Kim-Schulz S, Panelli MC et al. Serum vascular endothelial growth factor and fibronectin predict clinical response to high-dose IL-2 therapy. J. Clin. Oncol. 27(16), 2645–2652 (2009).

IL-2 therapy induces durable responses in a small proportion of patients with metastatic melanoma, a disease refractory to most anticancer treatments. However, administration requires intensive medical support; due to the risk of severe side effects, hence identification of likely responders or nonresponders would be of great clinical value. This study prospectively examined patient serum pre- and post-IL-2 infusion and analyzed for protein markers of response, in training and test sets. Elevated baseline levels of VEGF and fibronectin predicted a lack of response to IL-2 therapy and worse overall outcome. Serum VEGF is an easily measured biomarker and is a potentially clinically useful test to exclude patients unlikely to benefit from IL-2 treatment, if the results of this study are replicable. Significant biological questions are raised by this study and, furthermore, the use of IL-2 in the context of emerging molecular therapies for metastatic melanoma needs careful consideration.     

外阴接触性皮炎的发生及正确评估

女性外阴瘙痒是皮肤科及妇产科门诊的常见症状,外阴接触性皮炎是最常引起外阴瘙痒症状的原因之一。文中就外阴皮肤对于接触性刺激及过敏的敏感性,刺激性接触性皮炎(irritant contact dermatitis,ICD)及过敏性接触性皮炎(allergic contact dermatitis,ACD)的发病情况,外阴药物接触性皮炎及如何正确认识和评估外阴接触性皮炎等方面进行综述。     

体觉性耳鸣的临床研究

目的 探讨体觉性耳鸣的临床表现、诱发因素及对听力的影响.方法 分析2009年5月～2011年5月本科接诊的33例体觉性耳鸣患者的临床资料,对每位患者行纯音听阈测定.结果 33例体觉性耳鸣患者均有耳鸣伴眩晕,部分患者有耳闷胀感、颈肩痛、面部及下颌痛、头颈部肌肉痉挛及头痛等表现.患者发病前有明确的头颈部创伤病史等因素是体觉性耳鸣的诱发因素.患耳纯音听阈测定与健耳相比较,差异无统计学意义(P＞0.05).结论 体觉性耳鸣有较特征性的临床表现及诱发因素,对听力的影响不明显.     

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近年来花粉过敏的发病率逐年增高,已经成为世界各国所面临的重要的卫生问题之一。文章从花粉症的历史和流行病学、主要症状、诊断和鉴别诊断及治疗和预防等方面进行了较详细的介绍。     

Do patients with late-stage Parkinson's disease still respond to levodopa?

BackgroundLate-stage Parkinson’ disease (PD) is dominated by loss of autonomy due to motor and non-motor symptoms which can be marginally corrected by medications adjustments. However, controversy exists on the mechanisms underlying the apparent decrease of benefit from levodopa.ObjectiveTo study the response to levodopa in late-stage PD (LSPD).Methods20 LSPD patients (Schwab and England ADL Scale <50 or Hoehn Yahr Stage >3 in MED ON) and 22 PD patients treated with subthalamic deep brain stimulation (DBS) underwent an acute levodopa challenge test. MDS-UPDRS-III and the modified Abnormal Involuntary Movement Scale were evaluated in off and after administration of a supra-maximal levodopa dose.ResultsLSPD patients had a median age of 78.8 (IQR: 73.5–82) and median disease duration of 14 years (IQR: 10-19.75). DBS patients had a median age of 66 (IQR: 61-72) and median disease duration of 18 years (IQR: 15-22). LSPD and DBS patients' MDS-UPDRS-III score improved 11.3% and 37% after levodopa, respectively. Rest tremor showed the largest improvement, while axial signs did not improve in LSPD. However, the magnitude of levodopa response significantly correlated with dyskinesias severity in LSPD patients. One third of LSPD and 9% of DBS patients reported moderate drowsiness.ConclusionsLSPD patients show a slight response to a supra-maximal levodopa dose, which is greater if dyskinesia are present, but it is frequently associated with adverse effects. A decrease in levodopa response is a potential marker of disease progression in LSPD.     

Flexor and extensor muscle tone evaluated using the quantitative pendulum test in stroke and parkinsonian patients

The aim of this study was to evaluate the flexor and extensor muscle tone of the upper limbs in patients with spasticity or rigidity and to investigate the difference in hypertonia between spasticity and rigidity. The two experimental groups consisted of stroke patients and parkinsonian patients. The control group consisted of age and sex-matched normal subjects. Quantitative upper limb pendulum tests starting from both flexed and extended joint positions were conducted. System identification with a simple linear model was performed and model parameters were derived. The differences between the three groups and two starting positions were investigated by these model parameters and tested by two-way analysis of variance. In total, 57 subjects were recruited, including 22 controls, 14 stroke patients and 21 parkinsonian patients. While stiffness coefficient showed no difference among groups, the number of swings, relaxation index and damping coefficient showed changes suggesting significant hypertonia in the two patient groups. There was no difference between these two patient groups. The test starting from the extended position constantly manifested higher muscle tone in all three groups. In conclusion, the hypertonia of parkinsonian and stroke patients could not be differentiated by the modified pendulum test; the elbow extensors showed a higher muscle tone in both control and patient groups; and hypertonia of both parkinsonian and stroke patients is velocity dependent.     

Salivary gland transplantation for dry eye disease: Indications,techniques, and outcomes

The transplantation of salivary glands to the eye serves as a substitute for restoring tear volume in patients with severe dry eye disease. The lacrimal gland and salivary glands share similar acinar-ductal organization with some differences in the nature of secretions. This review summarizes the comparative anatomy of salivary and lacrimal glands, various salivary gland transplantation techniques, their indications, outcomes and complications along with future perspectives. Autologous microvascular submandibular gland transplantation (SMGT) into the temporal fossa with duct placement into the conjunctival fornix improves tear volume considerably but provides a hyposmolar tear film, which can induce corneal edema (in 3.5-40% of eyes). The transplanted submandibular graft improves tear volume and stability but visual acuity and conjunctival inflammation remain unchanged. The transplanted submandibular gland maintains stable function in the long-term and can have hypersecretion in 24–60% secondary to persistent autonomic innervation. Partial SMGT, gland reduction surgery, topical atropine gel or Botulinum Toxin A injection are options for treatment of postoperative epiphora. Minor salivary gland transplantation (MSGT) into the upper and/or lower conjunctival fornix results in an average improvement of 2–4 mm in Schirmer values compared to 16 to > 30 mm observed in eyes after SMGT. Reflex epiphora is rarely a problem in MSGT. Both MSGT or SMGT can improve the ocular surface and quality of life of patients with severe, debilitating dry eye disease. However, postoperative visual acuity and outcomes of corneal transplantation are still inconsistent. More studies and additional technical improvements are needed to further improve the results of these procedures.     

National survey of physicians in Japan regarding their use of diagnostic tests for legionellosis

IntroductionBacterial culture remains the gold standard for the diagnosis of legionellosis. However, past reports indicate that most physicians use the urinary antigen test (UAT) alone. Combining it with other tests is important, especially in patients with negative UAT results. The aim of this study was to investigate the current situation of legionellosis diagnostics and clarify the issues that need to be addressed.MethodsBetween March 1, 2021 and April 30, 2021, a questionnaire survey was conducted in an anonymous manner among physicians working in Japan. Questionnaires were generated on a website and asked questions in a multiple-choice format.ResultsValid responses were received from 309 physicians during the study period. Most (92.9%) physicians reported using UAT as the initial test for patients suspected of having legionellosis, and <10% reported using other tests (e.g., culture, nucleic acid amplification test [NAAT], Gimenez staining, and serum antibody titer measurement [ATM]). When the initial test result was negative, 63% of physicians reported not conducting additional tests. Even when they chose to run additional tests, at most 27.8%, 23.6%, 12.3%, and 10.4% of all physicians used NAAT, culture, Gimenez staining, and serum ATM, respectively. The major reasons for not using tests other than UAT were “unavailability in the medical facility,” “long turn-around time,” and “difficult to collect sputum.”ConclusionsThe present survey revealed that most physicians in Japan used UAT alone for diagnosing legionellosis. Eliminating barriers to creating a reasonable environment and edification of physicians are needed to improve the current situation.