BACTEC MGIT 960培养结合INNO-LIPA~(TM) RIF.TBDNA探针新技术快速诊断结核病

目的通过MGIT960培养系统结合国外最新的INNO -LIPATM RIF.TB(LIPA)DNA探针技术的应用 ,探讨其快速诊断结核病的可行性。方法应用BACTECMGIT960系统进行临床疑似结核病例标本的培养 ,筛选了70例结核分枝杆菌 ,35例非结核分枝杆菌 ,用LIPA探针技术诊断是否为结核分枝杆菌。结果用LIPADNA方法在70例结核分枝杆菌中获得阳性69例 ,占98.6 % ;35例非结核分枝杆菌均为阴性。与单纯消化纯化后涂片的82.9 % (58/70)的阳性率相比增加了15.7个百分点 ,两者在统计学上差异有显著性(P<0.05)。BactecMGIT960培养结合LIPADNA探针与传统诊断方法4～8周相比 ,整个过程只需6～37天 ,平均15天 (2周 )。结论LIPADNA探针是一种具有高度敏感性和特异性、能够简便、快速、准确地诊断结核病的新技术。同时还能鉴定rpoβ 基因位点的突变 ,诊断耐利福平 (RMP)性结核 ,有望适用于结核分枝杆菌耐RMP性结核的快速检测 ,进一步为结核病快速准确的治疗提供理论依据。     

Klebsiella pneumoniae bacteremia in the community hospital

The purpose of this study was to elicit the circumstances of occurrence and organism sensitivities of Klebsiella pneumoniae bacteremia in the community hospital, since data on this illness from the community hospital are rare. All records of documented Klebsiella pneumoniae bacteremia (46 cases) at Alachua General Hospital, Gainesville, Florida, over the period July 14, 1982, through July 27, 1985, were reviewed in detail. Fifty-nine percent (27 organisms) were nosocomial, whereas 41% (19 organisms) were community acquired. The most common predisposing disorders in these patients were, in decreasing order, malignancy; following gastrointestinal or biliary surgery; biliary tract obstruction; diabetes; and unknown. Twenty-two percent (10) of the patients died from bacteremia. The majority of organisms tested were sensitive to mezlocillin, cephalothin, cefoxitin, tetracycline, tobramycin, gentamicin, co-trimoxazole and ceftizoxime. Therapy was considered to be appropriate in 89% (41) of the patients and inappropriate in 10.9% (5) of the patients. Contrary to previous thought, Klebsiella pneumoniae bacteremia is a relatively common problem in the community hospital and may be community acquired as well as nosocomial. There are many characteristics of this disease in the community that are different from those reported in studies on Klebsiella pneumoniae bacteremia from large referral centers.     

安徽省实施结核病控制日本援助项目两年效果与评价

目的　了解两年来全省日本援助结核病控制项目县的实施情况。方法　按项目实施指南要求 ,检查2 0 0 2 -2 0 0 3年启动项目县有关结核病归口管理、结核病人的发现、治疗及管理情况 ,并现场作督导记录。结果　项目实施两年来 ,发现并入项涂阳结核病人 12 5 14例 ;2 0 0 2年入项的涂阳病人转归初治治愈率 86.3 % ,复治治愈率 70 .0 % ;2 0 0 3年入项的涂阳病人 2个月治疗后痰菌转阴率 ,初复治分别为 84.8%、70 % ;综合医院结核病转诊率平均 47.3 %。结论　项目工作进展较为顺利 ,但各项目县发展不平衡 ;切实落实结核病归口管理 ,加强病人发现工作 ,同时要特别加大对复治涂阳病人的督导管理力度 ,是做好项目“高治愈、高发现”的关键。     

A consistent model of insulin-dependent diabetes mellitus hypertension.

Hypertension is frequently seen in insulin-dependent diabetes mellitus (IDDM), but the mechanism of the hypertension is unknown. An animal model of IDDM hypertension could be helpful in determining the mechanism, but experimental IDDM has been infrequently and irregularly associated with hypertension. In an attempt to develop a consistent model of IDDM hypertension, we superimposed streptozotocin (STZ)-induced IDDM on surgical reduction of renal mass (RRM) in Wistar rats. Seven groups of rats were studied: 1) 60% RRM receiving 65 mg/kg body weight (BW) STZ; 2) 60% RRM receiving 40 mg/kg BW STZ; 3) 25% RRM receiving 65 mg/kg BW STZ; 4) two kidney normal rats receiving 65 mg/kg BW STZ; 5) 60% RRM receiving vehicle (control for group 1); 6) 60% RRM receiving vehicle (control for group 2); and 7) 25% RRM receiving vehicle. STZ produced diabetes and hypertension within 1 to 2 weeks in all three groups of RRM rats but blood pressure was unaffected by 60% or 25% RRM alone. STZ alone had no effect on blood pressure until the 5th week when the blood pressure increased slightly. Progressive weight loss resulted from 65 mg/kg BW STZ combined with 60% RRM; the animals had to be terminated after 5 weeks. In only 60% of animals with 40 mg/kg BW STZ plus 60% RRM was IDDM produced. On the other hand, 65 mg/kg BW STZ in rats with 25% RRM regularly produced IDDM and hypertension without excessive loss of body weight. In these rats, albuminuria developed in 2 weeks. Extracellular fluid volume was elevated and plasma renin activity was depressed. The animals were healthy and hypertensive when killed at the 13th week. We suggest that the 25% RRM rat receiving 65 mg/kg BW STZ is a consistent model of IDDM hypertension, which may be useful in probing the mechanism of this type of hypertension.     

A randomized three-way cross-over study in healthy pituitary-suppressed women to compare the bioavailability of human chorionic gonadotrophin (Pregnyl) after intramuscular and subcutaneous administration

The objective of this study was to compare the bioavailability of s.c. and i.m. administration of human chorionic gonadotrophin (HCG; Pregnyl). In a randomized, single-centre, three-way cross-over study, 18 healthy pituitary-suppressed volunteers were assigned to single HCG injections of 5000 and 10,000 IU i.m. and 10,000 IU s.c. Rate (Cmax, t(max)) and extent [area under curve from zero to infinity (AUC(0- infinity))] of absorption of HCG were determined. Serum immunoactive HCG increased from 0.4-0.5 IU/l at baseline to mean peak concentrations, which were reached 20 h after injection of 156 IU/l with 5000 IU i.m., of 307 IU/l with 10,000 IU i.m. and of 339 IU/l with 10,000 IU s.c. Eight days after administration, < 10% of the maximum HCG activity was found for each regimen. The elimination half-life (t(1/2)) was on average 32-33 h, irrespective of the treatment regimen. Intramuscular and s.c. injections of 10,000 IU HCG were bioequivalent with respect to AUC(0-infinity). The Cmax and t(max) were also similar between the two administration routes but bioequivalence could not be proven due to intersubject variability. Intramuscular doses of 5000 IU and 10,000 IU HCG were dose-proportional. Since s.c. HCG is bioequivalent to i.m. HCG with respect to extent of absorption (its major pharmacokinetic variable) and is well tolerated, the s.c. administration route may be effectively and safely used in assisted reproduction. Moreover, since s.c. injection can be performed by the patients themselves, acceptability may be enhanced.      

High frequency of benign mediastinal uptake of gallium-67 after completion of chemotherapy in children with high-grade non-Hodgkin's lymphoma

We observed increased gallium-67 uptake in the mediastinum after completion of chemotherapy in 10 of 62 patients with non-Hodgkin's lymphoma. All 10 were under 15 years of age, yielding a frequency of 43% in this age group. The interval between cessation of chemotherapy and the development of increased gallium-67 uptake ranged from 1 to 8 months, and the abnormality persisted for 2 to 59 months. Serial chest x-rays were performed in all patients, and four of the 10 had transient widening of the mediastinum that remained within normal limits for the children's ages. Three patients had chest computed tomographic (CT) scans at the time of increased gallium-67 uptake, and one of the three had serial scans that showed a mediastinal mass consistent with thymic enlargement. All of the patients were asymptomatic and none were biopsied. All 10 remained well, with a mean follow-up of 52.5 months. The phenomenon we describe is probably due to "rebound" thymic hyperplasia, which is a benign and transient condition. We conclude that abnormal mediastinal gallium-67 uptake after completion of chemotherapy is likely to be benign and transient if the patients are young, have small non-cleaved-cell histology, are without other evidence of lymphoma recurrence, and do not have initial mediastinal involvement. Progressive widening of the mediastinum on chest x-ray is cause for suspicion and requires further evaluation. Serum lactate dehydrogenase (LDH) levels may not be helpful in differentiating a benign from a malignant process.     

Prediction of fetal lung maturity: inaccuracy of study using conventional ultrasound instruments

The ability of three ultrasound (US) parameters--echogenicity, texture, and through transmission--to predict fetal lung maturity was tested in 59 patients using currently available clinical US equipment. The chi square test was used to determine whether there was an association between any single parameter and a "mature" lecithin/sphingomyelin (LS) ratio or specific phosphatidycholine (SPC). Multiple linear regression analysis was used to assess the combined ability of these three parameters and gestational age to predict LS ratio and SPC. There was no correlation between fetal lung maturity, as determined by mature LS and SPC indices, and the US parameters tested using unmodified clinical equipment.