ICU患者发生产ESBLs革兰阴性杆菌 感染的危险因素分析及预测模型的建立

[摘要]　目的　探讨ICU患者发生产超广谱β-内酰胺酶（extended spectrum beta-lactamases, ESBLs）革兰阴性杆菌感染的危险因素，并构建相关预测模型。方法　选取2017年5月—2021年4月我院ICU发生大肠埃希菌或肺炎克雷伯菌感染的189例患者作为研究对象，收集患者的临床资料，使用单因素分析、LASSO回归和多因素Logistic回归分析ICU患者30 d内发生产ESBLs革兰阴性杆菌感染的危险因素，并据此建立列线图预测模型。结果　急性生理与慢性健康评分≥16分、留置尿管时长≥7 d、抑酸剂使用时长≥3 d、第三代头孢菌素使用时长≥3 d、抗菌药物联用时长≥3 d和ICU住院时间≥15 d是ICU患者30 d内发生产ESBLs革兰阴性杆菌感染的危险因素（P均＜0.05）。依此建立预测ICU患者30 d内发生产ESBLs革兰阴性杆菌感染的列线图风险模型，模型验证结果显示C-index为0.795，校正曲线趋近于理想曲线，AUC为0.807（95%CI：0.775～0.839），在2%～81%预测范围内，列线图净获益。结论　ICU患者30 d内发生产ESBLs革兰阴性杆菌感染的危险因素包括APACHEⅡ评分≥16分、留置尿管时长≥7 d、抑酸剂使用时长≥3 d、第三代头孢菌素使用时长≥3 d、抗菌药物联用时长≥3 d和ICU住院时间≥15 d，据此构建的列线图模型能有效预测ICU患者30 d内发生产ESBLs革兰阴性杆菌感染的风险概率，具有一定的临床价值。     

薄层色谱法在当前中药质量标准中的应用探讨

薄层色谱鉴别在历版《中国药典》中的应用经历了从无到有、从少到多的过程；而薄层扫描含量测定在最近几版《中国药典》中的应用比例逐渐降低。随着对中药质量标准体系要求的进一步提高，薄层色谱法的不足之处陆续显现，如仪器普及率低、设备并不简单、结果重复性和稳定性较差、鉴别速度及准确性不及高效液相色谱法、展开剂毒性大等，逐渐不合时宜。在制定中药质量标准时，研究者不应该墨守成规，薄层色谱鉴别也不应该是雷打不动的定性鉴别必备选项。高效液相色谱法具备完全取代薄层色谱法的可行性，薄层色谱法可作为高效液相色谱法的补充。为充分降低检测成本、缩短检测周期、提高鉴别效率，笔者建议中药质量标准体系应该大幅减少薄层色谱鉴别方法的应用，增加高效液相特征图谱鉴定，尽量做到“一个条件，一张图谱”；除非确有必要，《中国药典》等国家质量标准体系应将薄层色谱鉴别作为推荐方法，而非强制标准。     

八段锦对视神经脊髓炎谱系疾病恢复情况的研究

[目的]评估规律性八段锦运动对视神经脊髓炎谱系疾病患者残疾状态及日常生活能力恢复情况的影响。[方法]选取视神经脊髓炎谱系疾病患者58例,随机分成试验组和对照组,每组29例,分别给予常规药物治疗+基础训练+八段锦干预、常规药物治疗+基础训练,疗程12周。比较两组扩展残疾状态量表(EDSS)评分、Barthel指数、Ashworth评分和疲劳严重度量表(FSS)评分的变化情况。[结果]试验组中,患者的EDSS评分、Barthel指数、Ashworth评分和FSS评分较干预前明显改善,差异具有统计学意义(P0.05);与对照组比较,EDSS评分和Barthel指数改善具有统计学意义(P0.05)。对照组中,患者Barthel指数、Ashworth评分和FSS评分较干预前明显改善(P0.05)。两组这4项指标的改善程度比较中,与对照组比较,试验组在EDSS评分、Barthel指数、Ashworth评分和FSS评分的改善程度更明显(P0.05)。[结论]规律的八段锦干预能明显改善视神经脊髓炎谱系疾病患者残疾状态、日常生活能力、肢体痉挛程度和疲劳状态,适合临床推广应用。     

MRI characteristics of MOG-Ab associated disease in adults: An update

Our knowledge of the radiological spectrum of myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD) is growing rapidly. An update on the radiological features of the disease, and its evolution is thus necessary. Magnetic resonance imaging (MRI) has an increasingly important role in the differential diagnosis of MOGAD particularly from aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD), and multiple sclerosis (MS). Differentiating these conditions is of prime importance because the management is different between the three inflammatory diseases, and thus could prevent further attack-related disability. Therefore, identifying the MRI features suggestive of MOGAD has diagnostic and prognostic implications. We herein review optic nerve, spinal cord and the brain MRI findings from MOGAD adult patients, and compare them to AQP4-NMOSD and MS.     

How is Anxiety Identified and Diagnosed in Individuals with Autism Spectrum Disorder and Intellectual Disability? A Scoping Review

ABSTRACT

Introduction: Individuals with Autism Spectrum Disorder display a pattern of social communication deficits and restricted and repetitive behaviors that leave them particularly vulnerable to developing anxiety. The presence of a co-occurring Intellectual Disability further complicates the situation, compromising traditional diagnostic techniques and processes. The dual diagnosis of ASD and ID appears to result in specific behavioral patterns that affect the way anxiety is identified in this population.

Method: A scoping review was undertaken to explore what is currently known about the way anxiety is identified and diagnosed in individuals with ASD and ID.

Results: In the limited research available consistent themes of difficulties with the diagnostic process, inconsistencies among measurement tools and the need to consider behavioral symptomology were found.

Conclusion: Further research needs to be conducted to enhance our understanding of how anxiety is identified in those with ASD and ID. This research could more accurately inform reliable diagnostic processes and lead to better treatment and outcomes for this population.     

An update on epidemiology,diagnosis & management of NMO-SD in the tertiary neurology department of Marrakech (Morocco)

IntroductionNeuromyelitis optica (NMO) and NMO spectrum disorders (NMO-SD) are inflammatory demyelinating diseases of the central nervous system. There are few epidemiological studies devoted to NMO, especially in Africa and the Middle East, but individual cases and series have been reported from many countries across the African continent.ObjectivesTo describe the epidemiology, diagnosis, and management of NMO patients followed at the Mohammed VI University Hospital of Marrakech.Patients and methodsThis was a hospital-based retrospective study of 52 patients with NMO diagnosed and followed at the Neurology department of the University Hospital of Marrakech from 2004 to July 2019. The 2006 diagnostic criteria of NMOSD were used for patients admitted before 2015 for inflammatory disease of the central nervous system and the 2015 diagnostic criteria of NMO-SD for all patients thereafter. Collected data were analysed using SPSS software.ResultsThe study concerned 52 patients, 18 males and 34 females. Median age at disease onset was 32.5 years (range 7–55). Mean time between symptom onset and diagnosis of NMO was nine months 18 days (range 7 days to 4 years). In most patients, manifestations included visual acuity, tetraparesis, and sensorial disorders. Refractory vomiting and hiccup were noted in the first attack in 19% of patients. Two patients had hypersomnia and polyphagia, and one had been treated for depression ten months before the development of severe tetraplegia. Magnetic resonance imaging did not show any brain lesions in 29% of patients. Cervical myelitis extending to more than three vertebrae was found in 60% of patients. AQP4-antibody assay was performed only in 57.7% of patients, and was positive in 38.4%; anti-MOG was positive in four anti-AQP4 seronegative patients. Management strategies for NMO-SD included methylprednisolone pulses (70% of patients), plasmapheresis (25%), and rituximab (since 2017) for 46%. Outcome was favourable in 40% of patients and has remained stable in 50% of them.ConclusionAnti-NMO assays, made available during the last five years with the help of The Guthy-Jackson Charitable Foundation, have led to a clear jump in the number of cases diagnosed. Major advances in the field of epidemiology, imaging, and pathophysiology of NMO-SD have led to improved patient care and outcome.