小儿感染性心内膜炎治疗的现状

Objective During recent years several changes have occurred in the clinical characteristics of infective endocarditis (IE) which has made a new challenge in the management of this disease. This study aimed to understand current practice pattern in the management of pediatric IE in China. Methods This retrospective, multicenter study was conducted in 13 hospitals. Clinical data of 268 patients diagnosed as IE according to the new IE criteria (trial) between 2000 and 2006 were analysed, focusing particularly on management and outcome of patients. The mean age of patients was 8.94 years (18 d-18 years). Results Except for one patient who died after admission without treatment, 56 antimicrobial agents were used in the management of this disease in the 267 patients, including cephalosporin group (15), penicillin group (8), beta-lactamase inhibitor combination (8), aminoglycosides (4), glycopeptide agents (3) etc. The most commonly used antibiotics were as follows: penicillin G (125 cases/times), cefotaxime (113), vancomycin (78), ceftriaxone (73), ampicillin (66), cefuroxime (56), piracillin (48), amikacin (39) etc. For management of this disease, only one antibiotic agent was used in 33 (12.3%) patients, two antibiotic agents in 83 (31.1%) patients, 3 antibiotic agents in 44 (16.5 %) patients, 4 antibiotic agents in 57(21.3%) patients, 5 antibiotic agents in 25(9.4%) patients, 6 or more antibiotic agents in 25 (9.4%) patients. The most commonly used antibiotic agents in patients with streptococci detected in blood culture were penicillin G, cephalosporins, vancomycin, beta-lactamase inhibitor combination, and aminoglycoside, in patients with staphylococcus detected in blood culture were cephalosporins, oxicillin, vancomycin, aminoglycoside, and quinolones. Duration of antibiotic treatment was from 1 day to 98 days, less than 2 weeks in 19 (7%) patients, 2 weeks to less than 4 weeks in 74 (27.7%) patients, 4-6 weeks in 122 (45.7%) patients, more than 6 weeks in 52 (19.4%) patients; 123 patients simultaneously underwent surgical management (for removal of vegetations and intracardiac defects or residual shunt repair 105, and valve repair 8, valve replacement 6, intracardiac defect repair 4) .Of the 268 patients, 186 patients were cured, 4 patients were referred to surgery, 18 patients died and 60 patients refused medical advice. In antibiotics and surgical treatment group (123 patients), 111 patients were cured, 4 patients were referred to surgery, 5 patients died, 3 patients refused medical advice, in antibiotics treatment group (145 patients), 75 patients were cured, 13 patients died, 57 patients refused medical advice. The outcomes were significantly different between the two groups (χ2=61.7, P=0.000). The results of multivariate logistic regression analysis showed that Staphylococcus aureus as a pathogen (χ2=4.40,P=0.036,OR=9.78,95% CI 1.16-82.26), children with repaired congenital heart disease (χ2=9.4,P=0.002,OR=9.8,95% CI 2.28-42.16), and complicated with heart failure (χ2=10.36,P=0.001, OR=0.075,95% CI 0.16-0.36) were risk factors related to death. Conclusion This study revealed the current status in the management of pediatric IE in China. Wide range antibiotic agents and diverse regimens are used to manage children with IE. For improving management of pediatric IE, there is an urgent need for guidelines or recommendations or consensus for management of pediatric IE stipulated by multidiscipline specialists, and randomized controlled clinical trials are required to provide evidences.     

In vitro activity of daptomycin against <Emphasis Type="Italic">Staphylococci</Emphasis> isolated from bacteremia and community-onset skin and soft tissue infections in France: data from two nationwide studies

Staphylococci are a leading cause of skin and soft tissue infections (SSTIs) and bacteremia in France, a country with a high prevalence of oxacillin resistance. We evaluated the in vitro activity of daptomycin compared with reference compounds against 445 Staphylococcus aureus and 53 coagulase-negative Staphylococci (CNS) collected during two large nationwide studies performed in 2006 and 2007. The percentage of oxacillin resistance among S. aureus was 13.6% (SSTIs) and 30.7% (bacteremia). Daptomycin showed lower MIC₉₀ levels compared to vancomycin, teicoplanin, and linezolid (0.19 mg/L vs. 2, 1.5, and 1 mg/L, respectively), irrespective of oxacillin susceptibility. Amongst the CNS, 64.2% of the isolates originated from clinical bacteremia were resistant to oxacillin and 24.5% to teicoplanin; all but one Staphylococci were susceptible to daptomycin (MIC = 1.5 mg/l). As with linezolid, daptomycin seems to constitute an alternative option to treat some staphylococcal infections in the French context of high oxacillin resistance prevalence and high glycopeptides MIC.     

Hytrosaviridae: a proposal for classification and nomenclature of a new insect virus family

Salivary gland hypertrophy viruses (SGHVs) have been identified from different dipteran species, such as the tsetse fly Glossina pallidipes (GpSGHV), the housefly Musca domestica (MdSGHV) and the narcissus bulbfly Merodon equestris (MeSGHV). These viruses share the following characteristics: (i) they produce non-occluded, enveloped, rod-shaped virions that measure 500–1,000 nm in length and 50–100 nm in diameter; (ii) they possess a large circular double-stranded DNA (dsDNA) genome ranging in size from 120 to 190 kbp and having G + C ratios ranging from 28 to 44%; (iii) they cause overt salivary gland hypertrophy (SGH) symptoms in dipteran adults and partial to complete sterility. The available information on the complete genome sequence of GpSGHV and MdSGHV indicates significant co-linearity between the two viral genomes, whereas no co-linearity was observed with baculoviruses, ascoviruses, entomopoxviruses, iridoviruses and nudiviruses, other large invertebrate DNA viruses. The DNA polymerases encoded by the SGHVs are of the type B and closely related, but they are phylogenetically distant from DNA polymerases encoded by other large dsDNA viruses. The great majority of SGHV ORFs could not be assigned by sequence comparison. Phylogenetic analysis of conserved genes clustered both SGHVs, but distantly from the nudiviruses and baculoviruses. On the basis of the available morphological, (patho)biological, genomic and phylogenetic data, we propose that the two viruses are members of a new virus family named Hytrosaviridae. This proposed family currently comprises two unassigned species, G. pallidipes salivary gland hypertrophy virus and M. domestica salivary gland hypertrophy virus, and a tentative unassigned species, M. equestris salivary gland hypertrophy virus. Here, we present the characteristics and the justification for establishing this new virus family.     

Responsiveness of the EQ-5D to HADS-identified anxiety and depression

Rationale  The use of generic measures of health-related quality of life enables cost effectiveness comparisons of different health care interventions to be made. Nevertheless, there exists a concern that generic instruments may be insufficiently sensitive to detect the differences or changes in outcome identified by condition-specific instruments. This paper compares the psychometric properties of the EQ-5D generic instrument with a widely used specific measure of distress, the Hospital Anxiety and Depression Scale (HADS).
Method  The analysis was based on data obtained from a large sample of women ( n  = 3119) with low-grade cervical cytological abnormalities detected at routine screening. These women completed EQ-5D and HADS questionnaires at recruitment and at 12 months thereafter. We examined the strength of association between HADS-determined severity of distress and EQ-5D scores at recruitment and between changes in severity and in scores over time.
Results  A higher likelihood of HADS-identified anxiety and/or depression was associated with significantly lower EQ-5D index and visual analogue scores. Over time, the EQ-5D score rose significantly when the likelihood of an individual representing a HADS-defined anxiety and/or depression case decreased.
Conclusion  We conclude that the EQ-5D has shown itself to be responsive to differing degrees of HADS-assessed distress, although generalization beyond the UK context requires further investigation.     

The epidemiology workforce: are we planning for the future?

Epidemiology has a central role in public health practice, education and research, and is arguably the only discipline unique to public health. A strong perception exists among epidemiologists in Australia that there is a substantial shortage in epidemiological capacity within the health workforce and health research, and that there are few graduates with sufficient high-level epidemiological training to fill the educational and leadership roles that will be essential to building this capacity. It was this concern that led the Australasian Epidemiological Association (AEA)--the peak professional body for epidemiologists in Australia and New Zealand--to convene a working group in 2007 to assess and address these concerns. This article summarises the key training challenges and opportunities discussed within this group, and the larger organisation, with the intention of stimulating greater public debate of these issues.     

肝细胞肝癌外科治疗方法的选择

2008年9月底制定了肝细胞肝癌外科治疗方法的选择,全文如下.