基于全基因组测序的耐碳青霉烯类抗生素鲍曼不动杆菌耐药基因、毒力因子及同源性分析

摘要：目的 通过应用全基因组测序(whole genome sequencing, WGS)技术分析某三级医疗机构耐碳青霉烯类抗生素鲍曼不 动杆菌(carbapenem-resistant Acinetobacter baumannii, CRAB)的耐药基因、毒力因子及同源性。方法 收集该院2020年1月至3月 重症监护病房(Intensive care unit, ICU)、神经外科分离的11株医院感染CRAB菌株，通过二代测序平台进行全基因组测序, 应用 基因组流行病学中心(Center for genomic epidemiology, CGE)ResFinder 4. 0软件分析其耐药基因型，并应用MORPHEUS在线制作 热图，应用毒力因子数据库(virulence factors of pathogenic bacteria, VFDB)VFanalyzer软件筛选毒力因子，应用MLST软件检测菌 株的ST型，应用Kaptive软件检测荚膜型，应用CSI Phylogeny 1. 4软件及FigTree v1. 4. 4软件构建最大似然树(maximum likelihood tree, MLT)以分析其同源性。结果 11株CRAB对亚胺培南、美罗培南、头孢菌素、环丙沙星均呈现耐药，而对阿米卡星、左氧 氟沙星耐药的菌株株数较少。11株CRAB共检测出18种耐药基因，11株同时携带碳青霉烯酶耐药基因blaOXA-23和blaOXA-66，β-内酰 胺酶耐药基因以blaTEM-1D和blaADC-25为主，大部分菌株携带多种外排泵相关耐药基因及抗菌药物修饰酶耐药基因。11株CRAB均携 带多种毒力因子，包括外膜孔蛋白、脂多糖、生物膜、外排泵、磷脂酶和效应蛋白等，如OmpA、Lps、Csu、Pga、Ade、Plc、 Bas、Bau、Ent、Hem、Aba、Bfm、Pbp和Kat等。11株CRAB均为ST2-K22型，同源性分析结果显示C组内同源性关系相近，存 在院内传播的可能。结论 该院CRAB的耐药性、毒力特征复杂多样，同源性分析显示该院存在1种优势克隆株，该克隆株有医 院内传播的风险。     

基于中国传统运动疗法的慢性筋骨病康复模式构建思路探析＊

中国传统运动疗法作为极具特色的康养健身运动疗法，在防病治病中的宝贵价值备受国际康复医学界关注。而慢性筋骨病是骨伤科临床中的常见病、多发病与疑难杂病，临床呈现出“一大五多五高”的特征，成为当前重大的健康问题与临床防治研究课题。本文通过深入探究中国传统运动疗法特点以及其在慢性筋骨病康复中的应用原理、原则及优势作用，提出以传统运动疗法为依托，构建慢性筋骨病防病治病应用方法模式；以三因制宜为指导，构建医院-社区-团体-患者为一体的康复管理模式；以“治未病”工程为支撑，构建慢性筋骨病管理信息资源共享平台模式；为切实提高防、控、治的能力与水平找准抓手与路径，为构建慢性筋骨病康复模式提供新的思路与方向。     

Effect of exercises according to the circadian rhythm in type 2 diabetes: Parallel-group,single-blind,crossover study

Background and aimTo evaluate the effectiveness of structured exercise appropriate the circadian rhythm in terms of blood sample test (BST), functionality and quality of life (QoL) in individuals with type 2 diabetes.Methods and resultsThis was a parallel-group, single-blind, crossover study. Thirty individuals with type 2 diabetes aged 35–65 years were enrolled in the study and allocated into 2 groups as the Morning Chronotype (MC) Group (n = 15) and the Evening Chronotype (EC) Group (n = 15) using Morningness-Eveningness Questionnaire which was used to determine the chronotypes. Participants were evaluated in terms of BST, functionality and QoL at the beginning of the study (T0), at 6 (T1), 12 (T2), and 18 (T3) weeks after the study started. A structured exercise program for 3 days a week over 6 weeks was applied in accordance with the chronotypes (T1-T2) and cross-controlled for the chronotypes (T2-T3). Significant differences were found in favor of the exercise given at the appropriate time for the chronotype in all parameters in both groups within groups (T0-T1-T2-T3) (p < 0.05). In the time1group interactions, exercise in accordance with the appropriate chronotype in both groups provided the highest statistical improvement in all parameters (p < 0.05).ConclusionIt was concluded that structured exercise performed at the appropriate time for chronotype improves HbA_1c, fasting blood glucose, HDL-LDL cholesterol, triglyceride, total cholesterol, functionality and quality of life in type 2 diabetes. This variation in blood values was observed to reflect the quantitative effects of exercise administered according to the circadian rhythm in individuals with type 2 diabetes.Trial registrationClinicalTrials.gov (NCT04427488). The protocol of the study was registered at ClinicalTrials.gov (NCT04427488).     

Emerging issue of fluconazole-resistant candidemia in a tertiary care hospital of southern italy: time for antifungal stewardship program

An increased number of patients is at risk of Candida spp. bloodstream infection (CBSI) in modern medicine. Moreover, the rising of antifungal resistance (AR) was recently reported. All consecutive CBSI occurred in our Hospital (consisting of 1,370 beds) between 2015 and 2018, were reviewed. For each case, Candida species, AR pattern, ward involved and demographic data of patients were recorded. Overall, 304 episodes of CBSI occurred, with a median (q1:first-,q3:third quartile) of 77 (71-82) CBSI/year. Over the years, a significant increase of CBSI due to C. albicans compared to non-albicans strains was recorded in medical wards (from 65% to 71%, p=0.030), while this ratio remained stable in others. An increase of resistant strains to multiple antifungals such as C. guillermondii was noticed in recent years (from 0% to 9.8%, p=0.008). Additionally, from 2015 to 2018 an increase in fluconazole-resistance was recorded in our Hospital (from 7.4% to 17.4%, p=0.025) and a slight increase in voriconazole-resistance (from 0% to 7% in 2018, p=0.161) was observed, while resistance to echinocandin and amphotericin B remained firmly below 2%.This study suggests a rapid spread of antifungal resistance in our Hospital; therefore, an appropriate antifungal stewardship programs is urgently warranted.     

Effects of virtual Reality-Based Training and aerobic training on gaming disorder,physical activity,physical fitness,and anxiety: A randomized,controlled trial

Background and aimThe effects of physical activity and exercise on gaming disorder severity in individuals with gaming disorder are unknown. The present study aimed to address the empirical gap in the current literature by comparing the effects of virtual reality-based training (VRT) and aerobic training (AT) exercise programs on gaming disorder severity, physical activity, physical fitness, and anxiety versus control group.Materials and methodsForty-four young male adults (18–28 years) with gaming disorder and a sedentary lifestyle were included in the study. The primary outcomes of the study were changes in gaming disorder severity and physical activity, and secondary outcomes included changes in physical fitness and anxiety levels. The participants were randomly assigned to VRT (n = 15), AT (n = 14) and control (n = 15) groups. Training sessions were performed at 50–70% of the maximal heart rate. Exercise programs consisted of 6 weeks of training 3 times a week for 30 min.ResultsThere was a decrease in the severity of gaming disorder as well as an increase in the level of physical activity in the VRT and AT exercise groups compared to the control group. In addition, a reduction was observed in the gaming time and sedentary time in both exercise groups versus control group. VRT group experienced greater improvements in physical fitness parameters than the AT group.ConclusionVRT and AT were effective in reducing gaming time and the severity of gaming disorder in individuals with gaming disorder. The therapeutic effects of VRT and AT can be used for reducing the severity of gaming disorder.     

模拟马术训练对脑卒中后共济失调的效果

目的 探索模拟马术训练对后循环卒中共济失调患者姿势控制、平衡、步行和日常生活活动能力的效果。     

The effects of multi-directional,high intensity exercise on the vestibular/ocular motor screening (VOMS) assessment in recreational athletes

ObjectiveIdentify the effects of multi-directional, high intensity exercise on VOMS symptom scores in male and female recreational, college-aged athletes.DesignCross-sectional study.SettingAthletic Therapy facility.ParticipantsA convenience sample of 29 (15 females, 14 males; 21.48 ± 1.40 years old) healthy recreational athletes.Main outcome measuresVOMS symptom scores pre, immediately post-, and 10 min post a multidirectional, high intensity intermittent exercise protocol (HIIP). Friedman tests and Wilcoxon Signed Rank tests identified significant differences at the time points. A Mann-Whitney U Test investigated the effect of sex.ResultsThe majority of component and overall VOMS symptom scores increased post-HIIP (p < 0.001–0.007, effect sizes 0.39–0.50) and 10 min post-HIIP (p = 0.003–0.015, effect sizes 0.32–0.39). Near point convergence distance increased immediately post-HIIP (p < 0.001, effect size 0.52). Females had higher smooth pursuits (z = −2.340, p = 0.019, r = 0.31), vertical vestibular ocular reflex (z = −2.81, p = 0.04, r = 0.39) visual motion sensitivity (z = −2.312, p = 0.021 r = 0.30) and overall VOMS symptom scores (z = −2.84, p = 0.04, r = 0.27) 10 min post-HIIP.ConclusionsMultidirectional, high intensity exercise can induce concussive-like changes in VOMS symptom scores in healthy, recreational athletes, particularly in females. These results may assist in SRC assessment and management of athletes involved in multidirectional, high intensity sports.     

妊娠期体育锻炼干预对自然分娩影响的Meta分析

背景 自然分娩是人类繁衍的正常生理过程，中国剖宫产率超出了世界卫生组织（WHO）提出的警戒线2倍多，而体育锻炼作为一种非药物性的健康干预方式，应引起相关部门的重视。 目的 运用Meta分析方法检验妊娠期体育锻炼对自然分娩影响的干预效果，并提出最优的锻炼方案。 方法 检索中国知网（CNKI）、中国生物医学文献服务系统（CBM）、维普网中文数据库和PubMed、EMBase、Web of Science、Cochrane Library英文数据库中有关妊娠期体育锻炼干预影响自然分娩结果的随机对照试验（其中干预组以体育锻炼干预为唯一干预方式，对照组进行常规护理知识教育或不进行有规律的体育锻炼），同时追踪相关系统评价所引用的参考文献，检索时间为1990—2021年。提取纳入文献资料，并对纳入文献进行方法学质量评价，采用RevMan 5.2软件进行Meta分析，运用GRADE工具对结局指标进行质量评价。 结果 共纳入30篇文献。Meta分析结果显示，干预组自然分娩发生率高于对照组〔RR=1.34，95%CI（1.28，1.40），P<0.000 01〕。亚组分析结果显示，锻炼开始节点对自然分娩的干预效果从高到低依次为：>24周、13~24周、≤12周；锻炼内容对自然分娩的干预效果从高到低依次为：盆底肌训练、运动课、体操、有氧运动、分娩球、瑜伽；锻炼频率对自然分娩的干预效果从高到低依次为：≥12次/周、3~5次/周、6~8次/周、9~11次/周；中等强度的锻炼较低强度的锻炼对自然分娩具有更大的影响；锻炼时长对自然分娩的干预效果从高到低依次为：30~<50 min/次、<30 min/次、≥50 min/次；锻炼周期对自然分娩的干预效果从高到低依次为：≤8周、17~24周、9~16周、25~34周。绘制体育锻炼干预对孕妇自然分娩影响的漏斗图，结果显示，漏斗图左右两侧基本对称，发表偏倚较小。运用GRADE工具对结局指标进行质量评价，结果显示，妊娠期体育锻炼影响自然分娩的评级为中等级。 结论 孕妇在妊娠期进行一定的体育锻炼对自然分娩结果具有良好的干预效果，且从妊娠期>24周开始锻炼、≥12次/周、30~<50 min/次、持续进行≤8周的中等强度的盆底肌训练、运动课、体操、有氧运动、分娩球以及瑜伽均对孕妇自然分娩的选择具有积极的影响。