Biochemical activities of lysosomal acid hydrolases in leukemic cells

The biochemical activities of 8 lysosomal acid hydrolases in leukemic cells from 48 patients were examined. Characteristic alterations were found in α-mannosidase, β-galactosidase and N-acetyl-β-glucosaminidase activities of leukemic cells. The level of α-mannosidase activity was much higher in myelo(mono)genous leukemias (AML, AMoL, AMMoL, CML and CMMoL) than in lymphogenous ones (ALL, T-cell leukemia, hairy cell leukemia and CLL) without exception. The β-galactosidase activity also differed as a result of α-mannosidase, except in T-cell leukemia. In T-cell leukemia it was within the range of normal lymphocytes, but in the other lymphogenous leukemias it was significantly below normal. N-acetyl-β-glucosaminidase activity in myelo(mono)genous leukemic cells was above the range of normal granulocytes. The changes in these enzyme levels were consistent. The lymphocytic or myelocytic nature of three cases of acute undifferentiated leukemia could be determined by enzyme studies. In two cases it was lymphocytic and in one it was myelocytic. The enzymatic abnormalities were also found in morphologically mature neutrophils from patients with not only chronic types (CML, CMMoL) but also acute types (AMoL, AMMoL) of leukemias, and were similar to those of their respective leukemic cells. Analysis of lysosomal enzymes (at least three of those mentioned above), can elucidate one of the biochemical properties of leukemic cells and may be valuable in the differentiation of leukemias.     

实时三维超声在胎儿心脏检查中的应用进展

先天性心脏病是心脏和大血管在胎儿时期发育异常所引起的畸形,是婴幼儿死亡的最常见原因.目前常规使用的二维胎儿超声心动图由于受到胎儿体位、声窗及检查者诊断经验等因素的限制,诊断准确性不高,且检查时间较长.随着超声技术的不断进步,实时三维超声成像技术能立体、直观地显示胎儿心脏的形态、结构及功能,对产前胎儿心血管畸形的发现,尤其是严重畸形的检出具有重要价值.本文就实时三维超声的成像原理、成像模式以及在胎儿心脏检查中的应用做一综述.     

Rat-bite fever due to Streptobacillus notomytis isolated from a human specimen

Rat-bite fever (RBF) is a disease that usually presents with fever, arthralgia and skin rash. Streptobacillus moniliformis was considered the main cause of RBF among the genus Streptobacillus. Although with similar clinical presentation, RBF due to Streptobacillus notomytis is unusual in humans. To the best of our knowledge, we present a case involving the first isolate of S. notomytis in humans. A 63-year-old woman was admitted to our hospital with fever, rash and polyarthritis. She recalled being bitten by a rat on her finger 5 days before presentation. Clinical manifestations were compatible with rat-bite fever (RBF) and the diagnosis was confirmed by the detection of Streptobacillus species from both blood and pustule samples. Initial polymerase chain reaction tests revealed that the organism was S. moniliformis. However, thorough genetic analysis revealed the organism to be S. notomytis. The condition was successfully treated with ampicillin.     

实时三维超声在心内膜垫缺损诊断中的应用

目的 探讨实时三维超声(RT-3DE)在诊断心内膜垫缺损(ECD)中的应用.方法 对32例ECD患者行常规二维超声与经胸RT-3DE检查,并与手术结果进行对照.结果 全部病例RT-3DE图像均满意采集,经旋转切割等后处理,其显示立体的房间隔、室间隔缺损结构、房室瓣发育及血流情况较常规二维超声更加直观、全面和准确.与手术...     

实时三维超声心动图对正常人二尖瓣闭合线稳定性的研究

目的 探讨实时三维超声心动图对正常人二尖瓣闭合线稳定性的研究.方法 实时三维超声心动图观察20名正常成年人的心脏,将二尖瓣数据导入三维工作站对闭合线进行重建分析.观察闭合线的空间结构特点,并测量在二尖瓣闭合周期内选取的5个时间点的闭合线指标：①闭合线两端点之间的直线距离;②投影平面上的闭合线曲线长度;③闭合线高度;④闭合线中间段和侧段的两个夹角：α和β角.结果 正常人二尖瓣闭合线呈一条平滑的基本对称的曲线,在整个二尖瓣闭合周期内其形态保持稳定.二尖瓣闭合线两端点之间的直线距离、投影平面上的曲线长度、闭合线高度、α角和β角均在闭合周期内不同时间点处的测值非常接近（P〉0.05）. 结论正常人的二尖瓣闭合线形态规则对称,在整个二尖瓣闭合周期内保持稳定形态.     

Mycobacterium heckeshornense lung infection diagnosed by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS)

Identification of microorganisms by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has been widely accepted. However, the significance of MALDI-TOF MS for identifying mycobacteria, particularly rare nontuberculous mycobacteria, has not been established. M. heckeshornense is one such bacteria, and distinguishing it from M. xenopi is difficult. The patient was a 40-year-old man with Beh?et's disease who had started treatment with prednisolone and azathioprine. A lung nodule in the right lower lobe was pointed out, and it increased in size 6 months later. Bronchoscopy was performed, and was culture positive for mycobacteria. It was identified as M. heckeshornense by MALDI-TOF MS with a score value of 1.928. Analysis of the 16S rRNA, rpoB, and hsp65 genes confirmed the result of MALDI-TOF MS. MALDI-TOF MS seems reliable for the diagnosis of M. heckeshornense infection.     

螺旋CT仿真内镜成像在喉部的临床应用

目的 探讨螺旋CT仿真内镜成像在喉部的临床应用。方法 对36例患者行喉部轴位薄层螺旋CT扫描，范围由会厌至环状软骨，层厚2～3mm，螺距1．0～1．5，1～1．5mm厚度进行三维重建，再把重建后的图像数据下载到CT工作站进行CTVE成像。结果 36例CTVE成像操作一次成功，获得满意的CTVE图像，声门及声门上、下区显示清楚。喉CT仿真内镜获得类似于纤维内镜显示喉内腔壁或腔内病变形态的效果，有利于微小病变的显示。36例中，CTVE发现异常者32例，正常者4例。结论 CTVE为一种无痛非侵入性检查方法，可从头端及足端进行观察，对声门下区的观察明显优于喉镜，特别适于隆起性病变的显示，可提高喉癌等隆起性病变的检出率。     

Clinical pharmacokinetic and pharmacodynamic analysis of daptomycin and the necessity of high-dose regimen in Japanese adult patients

The objective of this study was to explore the optimal dosage regimen of daptomycin and to determine the necessity and validity of a high-dose regimen from the perspectives of PK/PD parameters using Monte Carlo Simulation (MCS) and therapeutic drug monitoring (TDM) in a Japanese clinical setting. The volume of distribution (0.13 ± 0.012 L/kg) in this study was greater than that in healthy volunteers reported in Japan. The range of half-lives was between 8.9 and 34.9 h, which were gradually prolonged as creatinine clearance decreased. In MCS, the cumulative fractions of response (CFR) of the peak/MIC ≧ 60 and the AUC/MIC ≧ 666 at the 6 mg/kg q 24 h were 72.0% and 78.8% but at the 10 mg/kg q 24 h, the CFRs improved to both 99%. In TDM with 6 mg/kg q 24 h regimen, the patients who reached the peak and AUC target were 40% (2 out of 5 patients), respectively. The intraindividual variability in daptomycin PK may indicate the necessity of TDM and high-dose regimen, such as over 8 mg/kg, may be needed to ensure the effectiveness especially on Japanese patients with normal renal function.     

Risk factors for death from Stenotrophomonas maltophilia bacteremia

Purpose

Stenotrophomonas maltophilia has low pathogenicity potential, but if it causes bacteremia it can be fatal, because it has shown high resistance to many antibiotics and can be difficult to treat. Patient death from S. maltophilia bacteremia has increased since 2014 in our hospital. In this study, we investigated risk factors for death due to S. maltophilia bacteremia.

Bacterial peritonitis in a patient with malignant ascites caused by pancreatic carcinoma: Case report and review of literature

Bacterial peritonitis, an infection of the ascitic fluid, can be classified etiologically as spontaneous or secondary bacterial peritonitis. The former is mainly caused by portal hypertension and its subsequent effects, whereas the latter is caused by the direct dissemination of bacteria into the peritoneal cavity. Previous reports have described some distinguishing features of these two entities. Here, we report the first known case of bacterial peritonitis with Aeromonas hydrophilia and Escherichia coli in a patient with malignant ascites associated with pancreatic carcinoma who exhibited features of both spontaneous and secondary peritonitis. Our report suggests that clinicians should also consider bacterial peritonitis in patients with malignant ascites who present with ostensibly cancer-related symptoms.     

Distribution and annual changes in the proportion of Streptococcus pneumoniae serotypes in Japanese adults with pneumococcal pneumonia from 2011 to 2017

In 2014, vaccinations with 23-valent pneumococcal polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13) were implemented in Japan for all adults aged ≥65 years. We previously clarified reductions in the proportions of PCV7-, PCV13-, and PPSV23-covered serotypes in patients with pneumococcal pneumonia after the initiation of PCV7 and PCV13 vaccinations for Japanese children; however, information about the annual changes in the proportion of Streptococcus pneumoniae serotypes in patients with pneumococcal pneumonia after the initiation of routine PPSV23 vaccinations remains unclear. We retrospectively studied 229 adults with pneumococcal pneumonia which S. pneumoniae was cultured from their lower respiratory tract samples between 2011 and 2017 and investigated the annual changes in the proportion of S. pneumoniae serotypes. The proportion of PPSV23-covered serotypes decreased from 71.4% in 2011 to 52.2% in 2014, but it remained essentially unchanged from 2015 to 2017. The proportions of PCV7-covered serotypes decreased from 46.4% in 2011 to 4.3% in 2014; however, this rate increased beginning in 2015 and reached 20.6% in 2017. Among the PCV7-covered serotypes, the proportion of the 19F serotype increased from 2015 to 2017. In conclusion, there were no obvious changes in the proportion of PPSV23-covered and PCV13-covered serotypes in patients with pneumococcal pneumonia after the initiation of routine PPSV23 vaccinations.     

左心室短轴缩短率、射血分数评估α地中海贫血胎儿心功能的研究

目的 探讨M型超声心动图检测胎儿左心室收缩功能指标心室短轴缩短率（FS）、射血分数（EF）,评估α地中海贫血（α地贫）胎儿心功能状况的价值.方法 对78例孕龄16～40周胎儿有α地贫风险的单胎妊娠妇女行系统超声及M型超声心动图检查,分别测量胎儿左心室的FS、EF.地贫组胎儿36例,对照组42例.地贫组包括重型α地贫18例、中间型α地贫4例、轻型α地贫14例.随访妊娠结局.结果 所有胎儿左心室的FS、EF不随着孕龄的增加而递增.重型α地贫组胎儿FS低于对照组胎儿,差异有统计学意义（P＜0.01）;其他组胎儿的FS、EF两两比较,差异无统计学意义（P＞0.05）.结合二维超声声像图,左心室FS＜0.28、EF＜60%判断胎儿重型α地贫的敏感度为28%、特异度为86%.结论 左心室FS和EF可作为评估α地中海贫血胎儿心功能状况的一项重要指标.     

正常胎儿心脏三维全容积超声多平面成像率及影响因素分析

目的 分析正常胎儿心脏三维全容积数据后处理成像各切面的成像方法,探讨三维成像的影响因素,对比二维超声与三维超声各切面观成像率的差异.方法 147例经产后随访或超声复查证实无心脏畸形的正常胎儿,同时进行常规胎儿超声心动图和三维超声心动图数据采集,记录6个切面（四心腔、左室流出道、大动脉短轴、动脉导管弓、主动脉弓、下腔静脉与右房连接等）的成像情况,分析三维超声成像的影响因素及影响程度,比较二维及三维超声各切面的成像率.结果 胎儿三维全容积数据在四心腔、左室流出道、大动脉短轴、主动脉弓长轴、导管弓长轴及下腔静脉与右房连接切面的成像率分别为95.2%、 73.5%、51.0%、45.6%、46.9%及74.8%.对成像的影响有统计学意义的因素为胎位、肢体遮挡、胎盘遮挡、羊水覆盖.去除存在主要影响因素（胎位及肢体遮挡）的病例后,各切面的成像率分别为100%、93.9%、83.7%、75.5%及77.6%,前后成像率差异有统计学意义（P＜0.05）;比较无主要影响因素的病例,三维超声与二维超声在四心腔、左室流出道及下腔静脉右室连接切面成像率差异无统计学意义（P＞0.05）.结论 实时和容积三维超声心动图数据采集过程中要考虑各种因素对数据质量的影响,无主要影响因素的三维数据,心脏各切面观成像率较高,在四心腔、左室流出道及下腔静脉与右房连接三切面上可达到二维超声成像率的效果.     

Antimicrobial susceptibility surveillance of obligate anaerobic bacteria in the Kinki area

Obligate anaerobes exist as resident flora in various sites in humans, but they are also emphasized as endogenous causative microorganism of infections. We performed surveillance to understand the trend of drug susceptibility in obligate anaerobic bacteria in the Kinki area of Japan. In the experiment, we used 156 obligate anaerobe isolates collected from 13 institutions that participated in the Study of Bacterial Resistance Kinki Region of Japan. MALDI Biotyper was used to identify the collected strains, and among the 156 test strains, those that could be identified with an accuracy of Score Value 2.0 or more included 6 genera, 30 species, and 144 strains (Bacteroides spp. 77 strains, Parabacteroides sp. 2 strains, Prevotella spp. 29 strains, Fusobacterium spp. 14 strains, Porphyromonas spp. 2 strains, and Clostridioides difficile 20 strains), and they were assigned as subject strains for drug susceptibility testing. The drug susceptibility test was carried out by broth microdilution method using Kyokuto Opt Panel MP ANA (Kyokuto Pharmaceutical Industrial Co., Ltd., Tokyo, Japan) and judged according to CLSI criteria. As a result, Bacteroides and Parabacteroides species showed good sensitivities to tazobactam-piperacillin, imipenem, metronidazole and chloramphenicol, and low sensitivities to ampicillin, cefoperazone and vancomycin. Prevotella species showed good sensitivities to sulbactam-ampicillin, tazobactam-piperacillin, cefmetazole, imipenem, doripenem and metronidazole. Susceptibility rates to other drugs were slightly different depending on the bacterial species. Both Fusobacterium spp. and Porphyromonas spp. showed high sensitivities to many drugs. C. difficile was highly sensitive to vancomycin and metronidazole, having MIC₉₀s of 0.5 μg/mL and ≤2 μg/mL, respectively.     

Individual testimonies to nursing care after the atomic bombing of Hiroshima in 1945

Aim:  The aim of the present research is to clarify the nursing care conducted just before and after the atomic bombing of Hiroshima in 1945.
Methods:  Five surviving nurses, who were registered nursing staff at that time in Hiroshima, offered to participate in this research. Individual interviews were conducted in order to obtain the information concerning the nursing activities in the disaster-stricken areas. The collected information was collated with the documents with regard to the atomic bombing in Hiroshima, and compared with the current studies concerning nursing in disaster.
Findings:  The five nurses who participated in the study made it clear that, from the day of the bombing, nursing care activities changed moment by moment according to the condition of the radiation victims, the stricken areas and the relief systems. Under these circumstances, the nurses tried to help the victims of the bombing by devising anything useful for nursing care.
Conclusion:  The research participants left their messages, pointing out that nurses' mental attitude to those in front of them as patients is one of the most important things to keep in mind following any major disaster.     

护患双方认知的差异性对建立和谐护患关系的影响

[目的]了解护患双方对医患关系认知的差异性，为建立和谐护患关系提供实践指导依据。[方法]采取整群随机抽样方法，对浙江省某市城区4家医院的部分护士和病人进行问卷调查。[结果]护患双方除了对医患关系重要性的认知一致外，对医患关系的性质和发展趋势、医患冲突的常见诱因、主要解决方式等方面的认知情况均有统计学意义。[结论]护患双方对医患关系的认知差异是导致护患问有效沟通的障碍，相互理解和彼此尊重是解决认知分歧和建立和谐护患关系的根本要求。     

Systemic delivery of BH4 anti-apoptotic peptide using CPPs prevents cardiac ischemia-reperfusion injuries in vivo

There is an obvious need to develop pharmacological strategies to protect the heart in patients suffering from acute myocardial infarction. Apoptosis was evidenced as a main contributor of myocardial ischemia-reperfusion (IR) injury. Our cardioprotective strategy was based on the use of four cell penetrating peptides (CPP: Tat, (RXR)4, Bpep and Pip2b) which were conjugated to the BH4-peptide, derived from the BH4 domain of the Bcl-xL anti-apoptotic protein. These CPP-BH4 conjugates were able to reduce staurosporine-induced apoptosis in primary cardiomyocytes in vitro. Although Pip2b-BH4 was more efficient in terms of cellular uptake, it was as efficient as Tat-BH4 for its anti-apoptotic activity. As required for potential therapeutic application their cardioprotective effects were evaluated in an in vivo mouse model of myocardial IR injury.Our results clearly show that a single low dose (1 mg/kg) injection of Tat-BH4 and Pip2b-BH4 administered intravenously 5 min before reperfusion was able to drastically reduce infarct size (~ 47%) and to inhibit apoptosis (~ 60%) in the left ventricle of treated mice. Importantly, these effects are not observed following the injection of CPP alone or scrambled version of BH4. This study evidences that the Pip2b CPP, designed for oligonucleotides translocation, as well as the widely used natural Tat CPP exhibit similar efficacy in vivo to deliver BH4 anti-apoptotic peptide to the reperfused myocardium and may thus become useful therapeutic tools to treat acute myocardial infarction in the clinical setting.