预防血培养标本污染的最佳证据应用及临床实践黄莺₁ 陈瑜₂蒋红₁ 仝婕₁ 周蕾₁盛俐君₁

目的 针对感染科患者血培养标本管理,收集除实验室以外环节的最佳证据并应用于临床实践,以降低血培养标本的污染率。方法 将JBI临床证据实践应用系统和临床转化系统作为审查工具,基于现有血培养标本管理的最佳证据,制定6条审查指标。对45名护士、5名工勤人员实施基线审查和证据应用后第2轮审查。结果 第2轮审查中各条指标的执行率均达到100%,血培养标本污染率明确低于基线审查,且差异有统计学意义(P<0.05)。结论 基于循证的质量审查降低了血培养标本污染率。     

In vitro performance of prefilled CO<Subscript>2</Subscript> absorbers with the Aisys<Superscript>®</Superscript>

Low flow anesthesia increases the use of CO₂ absorbents, but independent data that compare canister life of the newest CO₂ absorbents are scarce. Seven different pre-packed CO₂ canisters were tested in vitro: Amsorb Plus, Spherasorb, LoFloSorb, Medisorb, Medisorb EF, LithoLyme, and SpiraLith. CO₂ (160 mL min^?1) flowed into the tip of a 2 L breathing bag that was ventilated with a tidal volume of 500 mL, a respiratory rate of 10/min, and an I:E ratio of 1:1 using the controlled mechanical ventilation mode of the Aisys ^® (GE, Madison, WI, USA). In part I, canister life of each brand (all of the same lot) was tested with 12 different fresh gas flows (FGF) ranging from 0.25 to 4 L min^?1. In part II, canister life of six canisters each of two different lots of each brand were tested with a 350 mL min^?1 FGF. Canister life is presented as “FCU”, fractional canister usage, the fraction of a canister used per hour, and is defined for the inspired CO₂ concentration (F_ICO₂) that denotes exhaustion. In part III, canister life per 100 g fresh granule content was calculated. FCU decreased linearly with increasing FGF. The relative position of the FCU–FGF curves of the different brands depends on the F_ICO₂ threshold because the exhaustion rate (the rate of rise once F_ICO₂ starts to increase) differs among the brands. Intra-lot variability was 18 % or less. The different prepacks can be ranked according their efficiency (least to most efficient) as follows: Amsorb Plus = Medisorb EF < LoFloSorb < Medisorb = Spherasorb = LithoLyme < SpiraLith (all for an F_ICO₂ threshold = 0.5 %). Canister life per 100 g fresh granule content is almost twice as long when LiOH is used as the primary absorbent. The most important factors that determine canister life of prepacks in a circle breathing system are the chemical composition of the canister, the absolute amount of absorbent present in the canister, and the F_ICO₂ replacement threshold. The use of the fractional canister usage allows cost comparisons among different prepacks. Results should not be extrapolated to prepacks that fit onto other anesthesia machines.     

Blood Clearance Kinetics,Biodistribution, and Radiation Dosimetry of a Kit-Formulated Integrin α<Subscript>v</Subscript>β<Subscript>3</Subscript>-Selective Radiotracer <Superscript>99m</Superscript>Tc-3PRGD<Subscript>2</Subscript> in Non-Human Primates

Purpose  

^99mTc-3PRGD₂ is a ^99mTc-labeled dimeric cyclic RGD peptide with increased receptor binding affinity and improved kinetics for in vivo imaging of integrin α_vβ₃ expression in nude mouse model. To accelerate its clinical translation, we reported here the evaluation of the kit-formulated ^99mTc-3PRGD₂ in healthy cynomolgus primates for its blood clearance kinetics, biodistribution, and radiation dosimetry.     

<Superscript>131</Superscript>I-Tositumomab (Bexxar®) <Emphasis Type="Italic">vs.</Emphasis><Superscript>90</Superscript>Y-Ibritumomab (Zevalin®) Therapy of Low-Grade Refractory/Relapsed Non-Hodgkin Lymphoma

Introduction

The American Cancer Society estimated 66,120 new cases of non-Hodgkin lymphoma (NHL) in the USA in 2008. Radioimmunotherapy has been shown in clinical trials to be an effective treatment for refractory/relapsed NHL. The available agents are Bexxar®, a ¹³¹I radiolabeled murine monoclonal antibody and Zevalin®, a ⁹⁰Y radiolabeled murine antibody. Both target CD20 receptors present on the surface of lymphocytes. We present our clinical experience with Bexxar® and Zevalin® in the management of low-grade refractory or relapsed NHL.

Methods

This is a retrospective study (Jan 2000–Jul 2006) of 67 patients with NHL, who were treated with Bexxar® (31 patients, group A) or Zevalin® (36 patients, group B) for refractory/relapsed disease. Group A included 16 men and 15 women, 35–81 years old (average, 59.3?±?13.4). Group B included 27 men and nine women, 36–85 years old (average, 55.4?±?13.8). Therapeutic doses ranged 40–138 mCi (average, 78.1?±?28.2) for Bexxar® and 17–34 mCi (average, 28.8?±?4.37) for Zevalin®.

Results

Objective responses were induced in 22 of the 31 patients (70.9%) in group A and 28 of the 36 patients (77.8%) in group B. Complete response was noted in 11 patients (35.5%), partial response in seven patients (22.6%), and mixed response in four patients (12.9%) in group A. There were five patients (16.1%) with stable disease and four patients (12.9%) with disease progression in the same group. Complete response was noted in 15 patients (41.7%), partial response in nine patients (25%), and mixed response in four patients (11.1%) in group B. There were four patients (11.1%) with stable disease and another four patients (11.1%) with disease progression in the same group. The average decreases at posttherapy nadir were 36.9%?±?0.33 (group A) and 52.6%?±?0.32 (group B) for platelets, 27.8%?±?0.27 (group A) and 34.2%?±?0.38 (group B) for leukocytes, and 4.9%?±?0.15 (group A) and 7.6%?±?0.11 (group B) for hemoglobin. Grades 3 and 4 hematological toxicity occurred in 14 patients (45.2%) treated with Bexxar® and 22 patients (61.1%) treated with Zevalin®, but was reversible.

Conclusion

Our study suggests that clinical practice of Bexxar® and Zevalin® radioimmunotherapy is an effective and safe adjunctive treatment for patients with NHL refractory/relapsed to conventional treatment. However, due to the small number of subjects, it was not possible to determine whether differences in the outcomes or toxicities from the two agents were statistically significant.

     

Comparison of [<Superscript>99m</Superscript>Tc]3PRGD<Subscript>2</Subscript> Imaging and [<Superscript>18</Superscript>F]FDG PET/CT in Breast Cancer and Expression of Integrin α<Subscript>v</Subscript>β<Subscript>3</Subscript> in Breast Cancer Vascular Endothelial Cells

Purpose

This study aimed to investigate the value of ^99mtechnetium-three polyethylene glycol spacers-arginine-glycine-aspartic acid ([^99mTc]3PRGD₂) imaging in diagnosis and staging of breast cancer compared with 2-deoxy-2-[¹⁸F]fluoro-D-glucose ([¹⁸F]FDG) imaging, and to explore the expression of integrin α_vβ₃ in tumor vascular endothelial cells.

Procedures

Forty-two women with suspected breast cancer underwent both [^99mTc]3PRGD₂ imaging and [¹⁸F]FDG imaging. Visual analysis was used to assess primary breast lesion, axillary lymph node, and distant metastasis. The tumor-blood (T/B) ratios from [^99mTc]3PRGD₂ imaging and the maximum standardized uptake value (SUVmax) from [¹⁸F]FDG imaging were analyzed for breast lesions. Integrin α_vβ₃ was analyzed through immunohistochemistry.

Results

Forty-five breast lesions were found (malignant, n?=?38; benign, n?=?7). The sensitivity, specificity, and accuracy of [^99mTc]3PRGD₂ and [¹⁸F]FDG imaging in visual analysis for the breast lesion were 97.4, 87.5, and 95.6 % and 97.4, 71.4, and 93.3 %, respectively (P?>?0.05). For semi-quantitative analysis, no significant difference of the area under the curves (AUC) was found in the imaging using the two radiopharmaceuticals (0.880 and 0.955; Z?=?0.88, P?>?0.05). The sensitivity, specificity, and accuracy for axillary lymph node metastasis with [^99mTc]3PRGD₂ and [¹⁸F]FDG were 78.05, 99.36, and 94.92 % and 85.37, 98.72, and 95.64 %, respectively (P?>?0.05). Nine patients with distant metastases were all detected with the two radiopharmaceuticals. The expression of integrin α_vβ₃ was correlated with [^99mTc]3PRGD₂ uptake (r?=?0.582, P?=?0.001), which were significantly higher in the HER2-positive and stage III–IV patients (P?<?0.05).

Conclusions

The prospective study demonstrated that [^99mTc]3PRGD₂ imaging seems to be valuable for diagnosis of breast cancer and its staging. It may be less sensitive for detecting small lymph node metastatic lesions when compared with [¹⁸F]FDG imaging. Integrin α_vβ₃ in tumor microvessels was associated with the breast cancer subtype and its staging.

     

Small (&lt;4 cm) clear cell renal cell carcinoma: correlation between CT findings and histologic grade

Purpose

To evaluate the correlation between CT findings and histologic grade of small clear cell renal cell carcinoma (ccRCC).

Methods

CT scans of 101 patients with small ccRCC were reviewed independently by two radiologists for tumor size, shape, margin, encapsulation, enhancement pattern, and visual relative enhancement. Enhancement patterns were defined according to the percentage of uniform enhancement [pattern 1, homogeneous (≥90%); pattern 2, relatively homogeneous (≥75 and <90%); and pattern 3, heterogeneous (<75%)]. Quantitative parameters representing attenuation and degree of enhancement were calculated. Histologic grade was classified as low (Fuhrman grade I or II) and high (Fuhrman grade III or IV). CT imaging variables were analyzed using univariate and multivariate analyses.

Results

A total of 63 low-grade and 38 high-grade small ccRCCs were assessed. Low-grade tumors differed from high-grade tumors with respect to enhancement pattern 1 or 2 (p < 0.001 and p < 0.001), smaller size (p = 0.002 and p = 0.001), and lower attenuation on unenhanced scan (p < 0.001 and p = 0.008). In multivariate analysis, enhancement pattern 1 or 2 and low attenuation (≤30 HU) were identified as independent predictors of low-grade ccRCC. Accuracy derived from logistic regression analysis was 79.2% for reader 1 and 70.3% for reader 2.

Conclusions

CT imaging features including tumor attenuation and enhancement pattern can be useful to predict the biologic behavior of small ccRCC for adequate treatment strategy.

     

6<Superscript>e</Superscript> Symposium International d’Aromathérapie et Plantes Médicinales (1<Superscript>re</Superscript> partie)

Compte rendu

6^e Symposium International dAromathérapie et Plantes Médicinales (1^re partie)     

In vitro performance of prefilled CO<Subscript>2</Subscript> absorbers with the Zeus®

Low fresh gas flows (FGFs) decrease the use of anesthetic gases, but increase CO₂ absorbent usage. CO₂ absorbent usage remains poorly quantified. The goal of this study is to determine canister life of 8 commercially available CO₂ absorbent prepacks with the Zeus^®. Pre-packed CO₂ canisters of 8 different brands were tested in vitro: Amsorb Plus, Spherasorb, LoFloSorb, LithoLyme, SpiraLith, SpheraSorb, Drägersorb 800+, Drägersorb Free, and CO2ntrol. CO₂ (160 mL min^??1) flowed into the tip of a 2 L breathing bag that was ventilated with a tidal volume of 500 mL, a respiratory rate of 10/min, and an I:E ratio of 1:1 using the controlled mechanical ventilation mode of the Zeus^® (Dräger, Lubeck, Germany). In part I, canister life of 5 canisters each of 2 different lots of each brand was determined with a 350 mL min^??1 FGF. Canister life is the time it takes for the inspired CO₂ concentration (F_ICO₂) to rise to 0.5%. In part II, canister life was measured accross a FGF range of 0.25 to 4 L min^??1 for Drägersorb 800+ (2 lots) and SpiraLith (1 lot). In part III, the calculated canister life per 100 g fresh granule content of the different brands was compared between the Zeus and (previously published data for) the Aisys. In vitro canister life of prefilled CO₂ absorber canisters differed between brands, and depended on the amount of CO₂ absorbent and chemical composition. Canister life expressed as FCU_0.5 (the fraction of the canister used per hour) was proportional to FGF over 0.2–2 L min^?1 range only, but was non-linear with higher FGF: FCU_0.5 was larger than expected with FGF?>?2 L min^?1, and even with FGF?>?minute ventilation FCU_0.5 did not become zero, indicating some CO₂ was being absorbed. Canister life on a per weight basis of the same brand is higher with the Zeus than the Aisys. Canister life of prefilled CO₂ absorber canisters differs between brands. The FCU_0.5–FGF relationship is not linear across the entire FGF range. Canister life of prepacks of the same brand for the Zeus and Aisys differs, the exact etiology of which is probably multifactorial, and may include differences in the absolute amount of absorbent and different rebreathing characteristics of the machines.     

Evaluation of the Microstat™ sublingual PCO<Subscript>2</Subscript> monitor in ambulatory patients

Physicians often need to measure arterial PCO₂ in clinical practice. Arterial blood gas sampling is typically available only in hospitals and may be unpleasant for patients. Minimally invasive techniques for measuring PCO₂ offer the potential for overcoming these limitations. The MicroStat monitor non-invasively measures PCO₂ in the sublingual tissues, which should track arterial PCO₂ in hemodynamically stable patients. This was a prospective observational study. Patients undergoing routine cardiac catheterization were recruited. Following arterial cannulation, two sequential sublingual PCO₂ measurements were taken and a contemporaneous arterial sample was sent for blood gas analysis. For each subject we calculated the mean sublingual–arterial CO₂ gradient and the test–retest sublingual PCO₂ difference. Twenty-five patients were studied. Mean sublingual–arterial PCO₂ gradient was +6.8 mmHg (95 % limits of agreement ?3.0 to 16.6 mmHg). Test–retest difference was 3.4 mmHg (95 % limits of agreement ?1.1 to 7.9 mmHg), p = 0.11 (Wilcoxon test), repeatability was 11 mmHg. The MicroStat sublingual PCO₂ monitor over-estimates arterial PCO₂ with wide limits of agreement. Test–retest repeatability was poor. Use of sublingual PCO2 monitoring with the MicroStat monitor cannot currently replace blood gas sampling.     

Antagonistic Actinomycetes Mediated Resistance in <Emphasis Type="Italic">Solanum lycopersicon</Emphasis> Mill. Against <Emphasis Type="Italic">Rhizoctonia solani</Emphasis> Kühn

Actinomycetes are a major group of beneficial microbes, which can be explored as spanking alternative to chemical fungicides for providing defense against phytopathogens. Rhizoctonia solani is a major havoc causing severe loss to many crops. Biological measures for fungal disease management are desired over the available chemical/synthetic fungicides owing to their safety towards non-target organisms. In the present study, 34 actinomycetes were isolated from vermicompost. Out of them, twelve revealed antifungal activity related to Indole acetic acid (IAA) production, siderophores and plant growth promotion. Under greenhouse and field conditions, these potent strains remarkably enhanced yield attributes and disease diminution as compared to untreated control. A significant disease reduction of 47–63 % against R. solani was observed in tomato plants pretreated with actinomycetes. Furthermore, induction in defense related enzymes such as peroxidase, polyphenol oxidase, phenylalanine ammonia lyase, accumulation of phenolics and flavonoids were also observed in actinomycetes treated plants. Morphological and molecular characterization analysis identified these potent isolates as Streptomyces sp. NBM3, Streptomyces sp. NBM2, Streptomyces sp. NBM1, Streptomyces sp. NBM12 and Streptomyces sp. NBM8. The present findings suggest that these microbes can be utilized for significant enhancement of plant growth and augmentation of defense related enzymes in order to cope up with R. solani induced stress, thereby contributing to crop health.     

Propriétés antioxydantes et antimicrobiennes des extraits de <Emphasis Type="Italic">Myrtus nivellei</Emphasis> Batt et Trab. obtenus <Emphasis Type="Italic">in situ</Emphasis> et <Emphasis Type="Italic">in vitro</Emphasis>

This work provides a contribution to the investigation and valorization of the Sahara-endemic plant: Myrtus nivellei Batt & Trab and the evaluation of the antioxidant effect of methanolic extracts harvested in situ, and in vitro propagated calli of this plant. Several spectrophotometric analyzes were performed, showing that the in situ methanolic extract was richer in polyphenols than the in vitro methanolic extract. Also, It expressed a good power to scavenge free radicals (EC50 = 0.98 mg/ml) and a great capacity to inhibit the peroxidation of linoleic acid estimated as 74.01%, largely higher than the ascorbic acid (50.57%) used as a positif control. However, the methanolic extracts of calli expressed the best ferric reducing power estimated as 66.71%. A very good antimicrobial activity was recorded for the extract of the plant harvested in situ, particularly against S. aureus (MIC=2.25 mg/ml), also against S. pneumoniae, S. flexineri, S. typhi and C. albicans (MIC=4.5 mg/ml). However, the calli extracts had presented no anti-microbial effect.     

Étude botanique et activité antifongique <Emphasis Type="Italic">in vitro</Emphasis> sur <Emphasis Type="Italic">Trichophyton mentagrophytes</Emphasis> de <Emphasis Type="Italic">Bersama abyssinica</Emphasis> Fresen. (Melianthaceae)

Objective: To evaluate the antifungal activity of the species most sought to improve the health of our poor people and especially immunocompromised.An ethnobotanical study conducted in the Department of Transua using questionnaires collected information on the therapeutic uses of antimicrobial plants in the region. It helped to inventory several plant species. Bersama abyssinica taxon is most stressed. Antifungal activity was tested using double dilution method in angle sloping tubes on Sabouraud Agar. Three extracts (ETA, EE70% and ERA) of tested leaves have antifungal activity on Trichophyton mentagrophytes. ERA was the most active (MIC=0.195±0.000 mg/ml, IC₅₀=0.024±0.010 mg/ml and MFC=0.195±0.000 mg/ml). These results reveal that the Department of Transua contain antimicrobial plants. Bersama abyssinica have antifungal activity on Trichophyton mentagrophytes. These results justify the use of this plant in the traditional treatment of fungal infections and opportunistic diseases associated with AIDS.     

Day-to-Day Test–Retest Variability of CBF,CMRO<Subscript>2</Subscript>, and OEF Measurements Using Dynamic <Superscript>15</Superscript>O PET Studies

Purpose  

We assessed test–retest variability of cerebral blood flow (CBF), cerebral blood volume (CBV), cerebral metabolic rate of oxygen (CMRO₂), and oxygen extraction fraction (OEF) measurements derived from dynamic ¹⁵O positron emission tomography (PET) scans.     

中国羊种布鲁氏菌<I>omp2</I>基因PstⅠ酶切多态性特征分析

目的拟发现中国羊种布鲁氏菌Iomp2/I基因PstⅠ酶切多态性特征。方法用聚合酶链反应-限制性片段长度多态性（PCR-RFLP）对羊种标准菌株、疫苗株M5、国内分离的羊种布鲁氏菌野毒株及非典型株共46株进行分析。结果Iomp2/I基因扩增产物经PstⅠ酶切后呈现两种酶切图谱,43/46有238 bp和44 bp 2个条带;仅羊1型标准株16M和两株青海非典型羊种1型菌有282 bp、238 bp和44 bp 3个条带。结论Iomp2/I基因PstⅠ酶切可为区分部分野生动物中的羊种菌和家畜羊种菌,为揭示布鲁氏菌的遗传衍化关系提供线索。