The best of times, the worst of times The global challenge of antimicrobial resistance

The development of resistance to antimicrobial agents by many bacterial pathogens has compromised traditional therapeutic regimens, making treatment of infections more difficult and frequently more expensive. Three factors have contributed to the development and spread of resistance: mutations in common genes that extend their spectrum of resistance, transfer of resistance genes among diverse microorganisms and increases in selective pressures in and outside of the hospital environment that enhance the development of resistant organisms. Some new resistance mechanisms are difficult to detect in the laboratory. Thus, resistant microorganisms may go unnoticed until they are widely disseminated in a hospital. The challenge for pharmacists, microbiologists and physicians is not only to contain the spread of existing resistant organisms, but also to prevent the emergence of new resistant pathogens by encouraging the rational and prudent use of antimicrobial agents.     

The best candidates for transarterial chemotherapy in patients with hepatocellular carcinoma awaiting liver transplantation: a cohort-based characterization of dropout times

BACKGROUND: Although transarterial chemotherapy is used to retard tumour progression for hepatocellular carcinoma (HCC) patients awaiting orthotopic liver transplantation (OLT), information regarding the acceptable waiting time and appropriate patient selection for the therapy is lacking. AIM: To examine dropout times and determine the best candidates for pre-transplant transarterial therapy in a cohort study. METHODS: In total, 180 consecutive HCC candidates receiving pre-transplant chemo-lipiodolization were included in the study. RESULTS: Overall, 70 (38.9%) patients dropped off the waiting list during the median follow-up of 19 months. According to the Child-Pugh (C-P) classification, the estimated dropout rates at 1 and 2 years were 17.2% and 44.8% for the C-P A group and 33.4% and 81.3% for the C-P B/C group, respectively. C-P B/C patients experienced more frequent dropouts than C-P A patients (P < 0.001). Risk factor analysis identified C-P classification to be the strongest predictor of dropout (P < 0.001). On multivariate analysis, alpha-fetoprotein (AFP) >100 ng/mL, tumour size >3 cm and multiple nodules remained independently predictive of dropout for C-P A group (all P < 0.05). Candidates with none of these factors were found to be at the lowest risk of dropout, with only a 22.5% dropout rate up to 41 months. CONCLUSIONS: This study suggests that Child-Pugh A patients with one nodule <3 cm and AFP < 100 ng/mL may be the best candidates for pre-transplant chemo-lipiodolization, with the lowest dropout rate. However, comparative studies with other therapeutic options are needed to assess the definitive role of transarterial therapy in this setting.     

The dissolution times of spherical particles

The differential equation governing the rate of change of radius of a spherical particle dissolving or growing in a fluid has been numerically integrated by computer. The particle radius, as a function of time, can thus be calculated, and the dependence of the overall particle lifetime upon physical parameters obtained. The effects of high mass flux, change of solubility with particle size, and progressive saturation due to dissolution into a finite volume of liquid can all be taken into account during the integration process. Results are presented for salicylic, boric and citric acids dissolving in and crystallizing from water; these represent the behaviour of sparingly soluble, moderately soluble and very soluble compounds respectively.     

昏迷患者院前转诊气道管理的方案比较

目的 探讨对昏迷患者院前急救转运最佳气道管理方案.方法 选取2005~2010年院前昏迷患者127例(格拉斯评分8以下),分别给于口咽通气管(A组)、普通喉罩(B组)及气管插管(C组),根据病情常规治疗,观察一次性置管时间、院前重复置管及安全转运.结果 口咽通气管组和普通喉罩组一次性置管时间明显少于气管插管组(P<0.01),然而安全转运成功率气管插管组较口咽通气管组和普通喉罩组有明显优势(P<0.05).结论 气管插管组对院前昏迷患者安全转诊提供较安全的气道保护.     

IVIG巴氏灭活的最佳条件

目的为了提高静脉注射人免疫球蛋白(IVIG)制品的病毒安全性,探索其巴氏灭活的可行性。方法在不加保护剂的条件下,调整不同的蛋白浓度、pH、电导,对IVIG液体样品进行巴氏灭活,并作各种理化性质分析。结果以制品分子大小分布为主要指标,优选出蛋白浓度1.0%~1.5%、pH3.8~4.2、电导值低于0.3ms的巴氏灭活条件。结论所用条件可在不加保护剂的情况下进行巴氏灭活时,加热对静脉注射人免疫球蛋白制品性质影响最小。     

慢病预防的最佳选择

从群体的层面通过干预来预防慢病不但可行而且成本低、效益高。国家或群体的收入水平不是成功的障碍。在群体层面的最佳选择指的是应该马上采取行动的，在救命、防病和省钱三方面都会快速见效的一些干预措施。世界卫生组织认为下面这10项措施是群体层面上的最佳选择：     

Quest for the best

By combining innovative science with years of massive investment, drug makers seek to turn newly discovered chemicals into revolutionary blockbuster drugs that generate billions of dollars in revenue. So every year, they collectively spend tens of billions of dollars on the high-risk pursuit of the next Prozac or Viagra. But should they? This article analyses key themes around differentiation that we have found to be common among blockbusters, and examines the implications for creating future billion-dollar drugs.     

热带医学的历史变迁和时代内涵

热带医学意指主要发生在热带和亚热带的传染性疾病或地区流行病,但随着时间推移和热带医学的发展,其内涵发生了深刻的变化.目前热带医学主要是一门涉及改善居住在或旅行到热带地区的人的健康和福利的学科.我国幅员辽阔,有相当的人民群众遭受着热带病的危害,而我国科研和临床工作者为热带病的防治亦做出了突出的贡献.近年来,随着经济全球化以及国家和地区间人员贸易往来的增多,热带医学正迎来其发展的新的机遇期.