Nuevos modelos predictivos de bacteriemia en el servicio de urgencias: un paso adelante

La atención de pacientes con sospecha de un proceso infeccioso en los servicios de urgencias hospitalarios(SUH) se ha incrementado en la última década hasta suponer alrededor del 15-20% de todas las atenciones diarias. En la valoración inicial de estos enfermos se toman muestras para los distintos estudios microbiológicos en un 45% de los casos, donde predomina la obtención de hemocultivos (HC), en el 14,6% de todos ellos. La rentabilidad diagnóstica de estos HC es muy variable (2-20%). Los focos o procesos infecciosos más frecuentes sospechados o confirmados de las bacteriemias verdaderas(BV) en los SUH son la infección del tracto urinario (45%) y la infección respiratoria (25%). Por todo ello, la sospecha y confirmación de la BV tiene un relevante significado diagnóstico, pronóstico y obliga a cambiar algunas de las decisiones más importantes a tomar en el SUH. Entre otras, indicar el alta o ingreso, extraer HC y administrar el antimicrobiano adecuado y precoz. La intención de esta revisión es poner de manifiesto las evidencias científicas publicadas en los últimos cinco años, aclarar las controversias existentes actuales y comparar la capacidad para predecir bacteriemia de los últimos modelos predictivos publicados desde el año 2017 con los ya existentes en esa fecha, año en el que se publicó una revisión que dejaba abierta la propuesta de seguir buscando un modelo con un rendimiento adecuado para los SUH. Y así, a partir de ella, generar distintas recomendaciones que ayuden a definir el papel que pueden tener estos modelos o escalas en la mejora de la indicación de obtención de los HC, así como en la toma inmediata de otras decisiones diagnóstico-terapéuticas (administración precoz y adecuada del tratamiento antibiótico, solicitud de estudios complementarios y otras muestras microbiológicas, intensidad del soporte hemodinámico, necesidad de ingreso, etc.)     

17β-Estradiol-Induced Synaptic Rearrangements Are Accompanied by Altered Ectonucleotidase Activities in Male Rat Hippocampal Synaptosomes

17β-Estradiol (E2) rapidly, by binding to membrane estrogen receptors, activates cell signaling cascades which induce formation of new dendritic spines in the hippocampus of males as in females, but the interaction with other metabolic processes, such as extracellular adenine nucleotides metabolism, are currently unknown. Extracellular adenine nucleotides play significant roles, controlling excitatory glutamatergic synapses and development of neural circuits and synaptic plasticity. Their precise regulation in the synaptic cleft is tightly controlled by ecto-nucleoside triphosphate diphosphohydrolase (NTPDase)/ecto-5′-nucleotidase (eN) enzyme chain. Therefore, we sought to clarify whether a single systemic injection of E2 in male rats is accompanied by changes in the expression of the pre- and postsynaptic proteins and downstream kinases linked to E2-induced synaptic rearrangement as well as alterations in NTPDase/eN pathway in the hippocampal synaptosomes. Obtained data showed activation of mammalian target of rapamycin and upregulation of key synaptic proteins necessary for spine formation, 24 h after systemic E2 administration. In E2-mediated conditions, we found downregulation of NTPDase1 and NTPDase2 and attenuation of adenine nucleotide hydrolysis by NTPDase/eN enzyme chain, without changes in NTPDase3 properties and augmentation of synaptic tissue-nonspecific alkaline phosphatase (TNAP) activity. Despite reduced NTPDase activities, increased TNAP activity probably prevents toxic accumulation of ATP in the extracellular milieu and also hydrolyzes accumulated ADP due to unchanged NTPDase3 activity. Thus, our initial evaluation supports idea of specific roles of different ectonucleotidases and their coordinated actions in E2-mediated spine remodeling and maintenance.     

葛根素对家兔脑缺血再灌注损伤的抗自由基作用

目的　观察葛根素 (Pur)对家兔脑缺血、缺血再灌注损伤的抗自由基作用。方法　以“四动脉阻断法”建立家兔全脑缺血再灌注损伤模型 ,观察缺血前、再灌注后应用Pur对家兔大脑皮质丙二醛 (MDA)、一氧化氮 (NO)含量及超氧化物歧化酶 (SOD)、一氧化氮合酶 (NOS)活性的影响。结果　家兔静脉注射Pur 3 0mg kg可显著减少缺血区脑组织的过氧化脂质MDA ,NO含量 ,提高SOD活性 ,降低NOS活性 ,缺血前应用Pur效应优于再灌注后应用 (P <0 .0 1)。结论　Pur可减轻自由基反应对脑组织的损害 ,对缺血的脑组织具有保护与复苏效应     

Long‐term oxygen treatment need is less frequent in eosinophilic COPD patients

IntroductionEosinophilic airway inflammation is a recognized inflammatory pattern in subgroups of patients with chronic obstructive pulmonary disease (COPD). However, there are still conflicting results between various studies concerning the effect of eosinophils in COPD patients. Our aim with this study was to evaluate eosinophilic inflammation and its relation to the clinical characteristics in a group of COPD patients.MethodsStable COPD patients with FEV₁% predicted < 50 or with ≥ 1 exacerbation leading to hospital admission or ≥2 moderate or severe exacerbation history were consecutively enrolled from outpatient clinics.ResultsWe included 90 male COPD patients, with a mean age of 63.3 ± 9.2. Mean FEV₁% predicted was 35.9 ± 11.3. Eosinophilic inflammation (eosinophil percentage ≥2%) was evident in 54 (60%) of the patients. Participants with eosinophilic inflammation were significantly older and had better FEV₁ predicted % values. Eosinophilic COPD patients were characterized with better quality of life and fewer symptoms. COPD patients with noneosinophilic inflammation used supplemental long‐term oxygen therapy (LTOT) more frequently compared to patients with eosinophilic inflammation (36.1% vs. 14.8%, p = 0.01). Eosinophilic inflammation is associated with less dyspnea severity measured by mMRC (OR: 0.542 95% CI: 0.342–0.859, p = 0.009) and less LTOT use (OR: 0.334 95% CI: 0.115–0.968, p = 0.04) regardless of age, severity of airflow limitation, and having frequent exacerbation phenotype.ConclusionOur study supports the growing evidence for a potential role of eosinophilic inflammation phenotype in COPD with distinctive clinical characteristics. Eosinophilic inflammation is inversely associated with dyspnea severity measured by mMRC and LTOT use independently from age, total number of exacerbations, St. George Respiratory Questionnaire (SGRQ) total score and FEV₁% predicted.     

山药种质与道地产区的沿革与变迁

山药始载于《神农本草经》,自古以来均来源于薯蓣科植物薯蓣.唐朝以前,山药主要来源于薯蓣的野生品,宋代开始有栽培,但医家认为野生者质量优良,明清以后主要来源于栽培品.随种质的变化,山药在明清以后以河南怀庆的栽培薯蓣为道地.在河南怀庆地区,山药长期的栽培出现品种分化.历代中医药学家均认为山药应以“色白、根细、坚实”为佳.这与现今怀山药的农家栽培品种之一的铁棍山药品质相一致.因此,道地药材“怀山药”不是泛指古怀庆地区（今河南焦作市、济源市和新乡市等地）种植的所有山药农家品种.怀山药的道地药材种质应该是符合中医药学家长期认可的特定农家品种——铁棍山药.     

贵阳地区2013年手足口病非 EV71、非 CVA16型肠道病毒的检测分析

目的：了解贵阳地区引起手足口病（HFMD）的非肠道病毒71型（EV71）、非柯萨奇病毒 A（CVA）16型肠道病毒的病原构成及优势型别,为贵阳地区 HFMD 防治工作提供依据。方法收集2013年4～6月检测为非 EV71、非 CVA16型肠道病毒的 HFMD 患者肛拭子标本共107例。提取病毒核酸,用巢式 RT-PCR 法扩增病毒 VP4区序列,对 PCR 阳性扩增产物进行测序,通过与 GenBank 收录的序列 BLAST 比对确定病毒型别;并对优势型别进行序列和进化分析。结果107例标本中共有100例标本巢式 RT-PCR 检测为阳性（93％）,其中100例 PCR 产物测序成功,经 BLAST 比对后,100例标本病毒型别均得到确定：CVA6为46例,CVA10为30例,CVA5为10例,CVA2为6例,CVA3和 CVA4各2例,CVB2和 ECHO16各2例。 CVA6在型别确定的非 EV71、非 CVA16型肠道病毒中占42．99％,为优势肠道病毒型别。结论贵阳地区引起 HFMD 的肠道病毒型别多样,CVA6为非 EV71、非 CVA16型肠道病毒中的优势型别。     

顶空-气相色谱法测定人参皂苷Rd原料中残留物的含量

目的 :建立人参皂苷Rd原料中溶剂和树脂残留物的测定方法。方法 :采用顶空进样 毛细管气相色谱法 ,色谱柱为CP Sil 8石英毛细管柱 (30m× 0 5 3mm ,5 μm) ;柱温 :5 0℃维持 5min ,以每分钟 15℃升温至16 0℃ ,维持 2min ;检测器 :FID ,温度 :2 80℃。用外标法测定人参皂苷Rd原料中溶剂和树脂残留物。结果 :建立的色谱方法在所考察的浓度范围内线性关系良好 ,各溶剂回收率符合要求。结论 :本实验建立的色谱方法适用于人参皂苷Rd原料中溶剂和树脂残留物的检测。     

进一步推动我国儿童伤害预防控制工作

伤害是危害我国儿童健康的重要公共卫生问题。我国已开展了大量预防儿童伤害的实践和科学研究，儿童伤害疾病负担已有所减轻，但伤害仍是造成儿童死亡的第1位原因，预防儿童伤害应被列为促进儿童健康的优先工作领域。健全和完善以政府为主导、多部门合作的儿童伤害预防机制，开展系统、全面、科学的儿童伤害预防控制工作，是降低我国儿童伤害疾病负担的重要策略。建议依托《"健康中国2030"规划纲要》完善伤害预防相关政策法规，制定和颁布实施儿童伤害预防行动计划，深入开展预防儿童伤害的实践和科学研究，加强儿童伤害防控的队伍建设和人才培养，以达到减少儿童伤害，促进儿童健康的目的。