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141.
Albrecht MT Li H Williamson ED LeButt CS Flick-Smith HC Quinn CP Westra H Galloway D Mateczun A Goldman S Groen H Baillie LW 《Infection and immunity》2007,75(11):5425-5433
The unpredictable nature of bioterrorism and the absence of real-time detection systems have highlighted the need for an efficient postexposure therapy for Bacillus anthracis infection. One approach is passive immunization through the administration of antibodies that mitigate the biological action of anthrax toxin. We isolated and characterized two protective fully human monoclonal antibodies with specificity for protective antigen (PA) and lethal factor (LF). These antibodies, designated IQNPA (anti-PA) and IQNLF (anti-LF), were developed as hybridomas from individuals immunized with licensed anthrax vaccine. The effective concentration of IQNPA that neutralized 50% of the toxin in anthrax toxin neutralization assays was 0.3 nM, while 0.1 nM IQNLF neutralized the same amount of toxin. When combined, the antibodies had additive neutralization efficacy. IQNPA binds to domain IV of PA containing the host cell receptor binding site, while IQNLF recognizes domain I containing the PA binding region in LF. A single 180-mug dose of either antibody given to A/J mice 2.5 h before challenge conferred 100% protection against a lethal intraperitoneal spore challenge with 24 50% lethal doses [LD50s] of B. anthracis Sterne and against rechallenge on day 20 with a more aggressive challenge dose of 41 LD50s. Mice treated with either antibody and infected with B. anthracis Sterne developed detectable murine anti-PA and anti-LF immunoglobulin G antibody responses by day 17 that were dependent on which antibody the mice had received. Based on these results, IQNPA and IQNLF act independently during prophylactic anthrax treatment and do not interfere with the establishment of endogenous immunity. 相似文献
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Conrad M. Tobert Sarah L. Mott Kenneth G. Nepple 《Journal of the Academy of Nutrition and Dietetics》2018,118(1):125-131
Background
Malnutrition is a significant problem for hospitalized patients. However, the true prevalence of reported malnutrition diagnosis in real-world clinical practice is largely unknown. Using a large collaborative multi-institutional database, the rate of malnutrition diagnosis was assessed and used to assess institutional variables associated with higher rates of malnutrition diagnosis.Objective
The aim of this study was to define the prevalence of malnutrition diagnosis reported among inpatient hospitalizations.Design
The University Health System Consortium (Vizient) database was retrospectively reviewed for reported rates of malnutrition diagnosis.Participants/setting
All adult inpatient hospitalization at 105 member institutions during fiscal years 2014 and 2015 were evaluated.Main outcome measures
Malnutrition diagnosis based on the presence of an International Classification of Diseases-Ninth Revision diagnosis code.Statistical analysis
Hospital volume and publicly available hospital rankings and patient satisfaction scores were obtained. Multiple regression analysis was performed to assess the association between these variables and reported rates of malnutrition.Results
A total of 5,896,792 hospitalizations were identified from 105 institutions during the 2-year period. It was found that 292,754 patients (5.0%) had a malnutrition diagnosis during their hospital stay. By institution, median rate of malnutrition diagnosis during hospitalization was 4.0%, whereas the rate of severe malnutrition diagnosis was 0.9%. There was a statistically significant increase in malnutrition diagnosis from 4.0% to 4.9% between 2014 and 2015 (P<0.01). Institutional factors associated with increased diagnosis of malnutrition were higher hospital volume, hospital ranking, and patient satisfaction scores (P<0.01).Conclusions
Missing a malnutrition diagnosis appears to be a universal issue because the rate of malnutrition diagnosis was consistently low across academic medical centers. Institutional variables were associated with the prevalence of malnutrition diagnosis, which suggests that institutional culture influences malnutrition diagnosis. Quality improvement efforts aimed at improved structure and process appear to be needed to improve the identification of malnutrition. 相似文献145.
Ronald D. Williams Jr. Jeff M. Housman Conrad L. Woolsey Thomas E. Sather 《Substance use & misuse》2018,53(1):137-142
Background: About 30% of high school students use energy drinks. Alcohol mixed with energy drinks (AmED) has been associated with higher rates of risky driving among college students. Objectives: The purpose of this study was to: (a) examine AmED-use in a sample of high school students and (b) to specifically investigate differences in risky driving behaviors between 12th grade students who engaged in AmED-use and those who consumed alcohol only. Methods: Differences in risky driving behaviors were investigated by utilizing secondary data analyses of nationally representative data from the Monitoring the Future Study (N = 1305). Results: 12th grade AmED users were significantly more likely to be in a motor vehicle accident (p <.001) and receive a ticket for a traffic violation (p <.05). Additionally, 12th grade AmED users were significantly less likely to wear a seatbelt as a driver or passenger (p <.001). Conclusions/Importance: Although this study does not link risky driving behaviors to specific drinking events, it does indicate a relationship between AmED-use and high-risk driving. Because traffic accidents are the highest cause of mortality among U.S. teenagers, drug education efforts to reduce high-risk driving behaviors should include information on the decision-making and synergistic effects of energy drinks when mixed with alcohol. 相似文献
146.
Deverick J Anderson Luke F Chen David J Weber Rebekah W Moehring Sarah S Lewis Patricia F Triplett Michael Blocker Paul Becherer J Conrad Schwab Lauren P Knelson Yuliya Lokhnygina William A Rutalo Hajimori Kanamori Marina F Gergen Daniel J Sexton for the CDC Prevention Epicenters Program 《中华医院感染学杂志》2018,(12)
中文:背景患者入院后可从不当消毒的环境表面获得多药耐药菌和艰难梭菌。本文确定了3种强化的终末消毒(入住同一病房的两名患者之间的消毒)策略,对感染耐甲氧西林金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE)、艰难梭菌(CD)和多重耐药不动杆菌的影响。方法本文在美国东南部的9家医院开展了一项务实的、集群-随机、交叉研究。凡曾有感染或定植目标细菌感染患者居住过的病房,患者出院后随机采取4种消毒策略中的一种方法进行终末消毒:对照(季胺盐类消毒剂消毒,但凡遇到CD采用含氯消毒剂);UV(季胺盐类+UV-C消毒,但凡遇到CD采用含氯消毒剂+UV-C);含氯消毒剂;含氯消毒剂+UV-C。凡入住目标病房的患者被列为暴露人群。这4种终末消毒方法分别在每家医院连续实施7个月的周期。本文随机设计这几种消毒策略在每家医院内的实施顺序(1:1:1:1)。主要产出的结果是,观察暴露患者中目标细菌的感染的发生或定植情况,以及ITT人群中暴露患者CD感染发生率。本研究ClinicalTrials.gov注册编号:NCT01579370。结果共有31 226名患者暴露,其中21 395(69%)符合标准,包括4 916名对照组,5 178名UV组,5 438名含氯消毒剂组,以及5 863名含氯消毒剂+UV组。在对照组中,22 426个暴露日中有115名患者发生目标细菌的感染(51.3/10000暴露日)。在标准清洁策略的基础上增加UV消毒的暴露患者,其目标细菌感染的发生率明显较低(n=76;33.9/10 000暴露日;RR:0.70,95%CI:0.50~0.988;P=0.036)。含氯消毒剂组(n=101;41.6/10 000暴露日;RR:0.85,95%CI:0.69~1.04;P=0.116),或含氯消毒剂+UV组患者(n=131;45.6/10 000暴露日;RR:0.91,95%CI:0.76~1.09;P=0.303)的目标细菌的感染率,其差异无统计学意义。同样,在含氯消毒剂的基础上增加UV消毒,暴露患者中CD感染率也没有发生改变((n=38 vs 36;30.4 vs 31.6/10 000暴露日;RR:1.0,95%CI:0.57-1.75;P=0.997)。解释污染的医疗机构环境是获得病原微生物的重要来源;强化终末消毒可以降低这一风险。 相似文献
147.
OBJECTIVE: To describe the use of pumpless arteriovenous carbon dioxide removal in support of four pediatric patients with near-fatal asthma. DESIGN: Report of four cases. SETTING: Tertiary care university pediatric intensive care unit. PATIENTS: Four pediatric patients, ages 4, 10, 12, and 13, were intubated and initially managed with positive pressure ventilation for severe respiratory failure. Despite pharmacologic therapy with inhaled beta-agonists, inhaled anticholinergics, systemic corticosteroids, and intravenous magnesium, marked progressive hypercapnia and acidosis rapidly developed requiring high levels of positive pressure ventilation. INTERVENTIONS: Application of pumpless arteriovenous carbon dioxide removal (AVCO2R) via percutaneous femoral cannulation. MEASUREMENT AND MAIN RESULTS: Arterial or mixed venous carbon dioxide partial pressure (PCO2) and pH were measured before and at intervals following initiation of AVCO2R. Before cannulation, PCO2 was elevated to 100, 108, 90, and 186 mm Hg in the four patients, with corresponding pH of 7.07, 6.96, 7.09, and 6.80, respectively. Pco2 levels were reduced to more acceptable levels (37-57 mm Hg) within 2-4 hrs of initiation of AVCO2R, with corresponding improvements in pH despite reductions in ventilatory frequency and tidal volumes to safe levels. Duration of support ranged from 18 hrs to 5 days during resolution of bronchospasm. No red blood cell or platelet transfusions were required, and no complications resulted from AVCO2R or from mechanical ventilation. All patients were discharged from the hospital without sequelae. CONCLUSIONS: Percutaneous cannulation with a simplified pumpless extracorporeal circuit is capable of removing sufficient carbon dioxide to allow application of a protective ventilatory strategy in severe hypercapnic pediatric respiratory failure. The procedure was safely applied without complications in four pediatric patients as young as 4 yrs of age. 相似文献
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149.
Patient-specific guides can improve limb alignment and implant positioning in total knee arthroplasty, although not all studies have supported this benefit. We compared the radiographs of 100 consecutively-performed patient-specific total knees to a similar group that was implanted with conventional instruments instead. The patient-specific group showed more accurate reproduction of the theoretically ideal mechanical axis, with fewer outliers, but implant positioning was comparable between groups. Our odds ratio comparison showed that the patient-specific group was 1.8 times more likely to be within the desired + 3° from the neutral mechanical axis when compared to the standard control group. Our data suggest that reliable reproduction of the limb mechanical axis may accrue from patient-specific guides in total knee arthroplasty when compared to standard, intramedullary instrumentation. 相似文献
150.
Sae Takada Ph.D. M.H.S. Sheri D. Weiser M.D. M.A. M.P.H. Elias Kumbakumba M.D. Conrad Muzoora M.D. Jeffrey N. Martin M.D. M.P.H. Peter W. Hunt M.D. Jessica E. Haberer M.D. M.S. Annet Kawuma M.D. David R. Bangsberg M.D. M.P.H. Alexander C. Tsai M.D. Ph.D. 《Annals of behavioral medicine》2014,48(1):26-37