True Dopers or Negligent Athletes? An Analysis of Anti-Doping Rule Violations Reported to the World Anti-Doping Agency 2010–2012

Background: The sanction that an athlete receives when an anti-doping rule violation has been committed depends on the specific circumstances of the case. Anti-doping tribunals decide on the final sanction, following the rules of the World Anti-Doping Code. Objectives: To assess the athletes’ degree of fault based on the length of sanctions imposed on them to feed policy-related discussions. Methods: Analysing data from the results management database of the World Anti-Doping Agency for anonymous information of anti-doping rule violations in eight selected sports covering the years 2010-2012. Results: Four out of ten athletes who committed an anti-doping rule violation received a suspension that was lower than the standard. This is an indication that tribunals in many instances are not convinced that the athletes concerned were completely at fault, that mitigating circumstances were applicable, or that full responsibility of the suspected violation should not be held against them. Anabolic agents, peptide hormones, and hormone modulators lead to higher sanctions, as do combinations of several anti-doping rule violations. Conclusions: This first analysis of information from the World Anti-Doping Agency's results management database indicates that a large proportion of the athletes who commit anti-doping rule violations may have done this unintentionally. Anti-doping professionals should strive to improve this situation in various ways.     

Fluid shifts have no influence on ciprofloxacin pharmacokinetics in intensive care patients with intra-abdominal sepsis

This study aimed to investigate whether fluid shifts alter ciprofloxacin pharmacokinetics in critically ill patients over time. Patients > or = 18 years, with normal renal function, requiring intensive care treatment and parenteral antibiotics were enrolled. Group A (22 patients) included patients with documented intra-abdominal infections. Group B (18 patients) included patients with severe sepsis from other causes. All patients received intravenous ciprofloxacin 400 mg every 8 h infused over 60 min. Eight timed blood specimens were taken on days 0, 2 and 7. Ciprofloxacin plasma concentrations were determined using high performance liquid chromatography. There were no significant differences between the pharmacokinetics of the two groups or over time. Ciprofloxacin pharmacokinetics in critically ill patients do not change over time, and intra-abdominal sepsis does not alter ciprofloxacin pharmacokinetic parameters to a greater degree than sepsis from other causes in critically ill patients.     

弧形切割吻合器在低位直肠癌治疗中的应用

目的 评价弧形切割吻合器在低位直肠癌保肛手术中的应用.方法 回顾分析2006年至2008年使用弧形切割吻合器行低位直肠癌保肛手术22例患者的临床资料.结果 22例行保肛手术,1例发生亚临床微小瘘,保守治疗痊愈,无吻合口出血,无局部复发,两例患者分别于术后12、14个月死亡.结论 弧形切割吻合器有利于低位直肠癌保肛手术的开展,可提高保肛率.     

Role of Atypical Pathogens in Nursing Home–Acquired Pneumonia

ObjectivesNo international consensus has been reached on the empirical use of antibiotics with atypical coverage in nursing home–acquired pneumonia (NHAP). Aspiration is an important cause of NHAP, but it may not require antimicrobial treatment. This study aimed to investigate the prevalence and clinical characteristics of AP infections and review the need for empirical antibiotics with atypical coverage in NHAP.DesignA prospective cohort study.SettingFour nursing homes with a total number of 772 residents.ParticipantsPatients were aged ≥ 65 years, hospitalized for NHAP, which was defined as the presence of respiratory symptoms and abnormal chest radiographs, from April 2006 to March 2007.MeasurementsDemographics, clinical parameters, and investigation results were recorded. Microbial investigations comprised sputum routine and mycobacterial cultures, blood and urine cultures, serology, and nasopharyngeal aspirate viral culture and polymerase chain reaction tests. Suspected aspiration pneumonitis was arbitrarily defined as NHAP without pathogens identified.ResultsAfter excluding lone bacteriuria, 108 episodes of NHAP in 94 patients were included. Twelve APs were detected in 11 patients. There was no clinical feature to distinguish between infections caused by APs and other pathogens. The commonest APs were Mycoplasma pneumoniae (6) and Chlamydophila pneumoniae (3). No Legionella pneumophila was detected by urinary antigen test. None of the patients with AP infection received antibiotics indicated for AP infections. However, AP infections did not result in mortality. No pathogen was isolated in 31.5% of cases. Patients without pathogens isolated were less likely to have purulent sputum and crepitations on chest auscultation, compared with those with pneumonia caused by identified pathogens.ConclusionsAtypical pathogens (APs) were not associated with mortality even in cases where the prescribed antibiotics did not cover APs. NHAP may not necessarily be treated with empirical antibiotics covering APs.     

Comparison of qualitative and quantitative fit-testing results for three commonly used respirators in the healthcare sector

N95 filtering facepiece respirators are used by healthcare workers when there is a risk of exposure to airborne hazards during aerosol-generating procedures. Respirator fit-testing is required prior to use to ensure that the selected respirator provides an adequate face seal. Two common fit-test methods can be employed: qualitative fit-test (QLFT) or quantitative fit-test (QNFT). Respiratory protection standards deem both fit-tests to be acceptable. However, previous studies have indicated that fit-test results may differ between QLFT and QNFT and that the outcomes may also be influenced by the type of respirator model. The aim of this study was to determine if there is a difference in fit-test outcomes with our suite of respirators, 3M - 1860S, 1860, AND 1870, and whether the model impacts the fit-test results.

Subjects were recruited from residential care facilities. Each participant was assigned a respirator and underwent sequential QLFT and QNFT fit-tests and the results (either pass or fail) were recorded. To ascertain the degree of agreement between the two fit-tests, a Kappa (Κ) statistic was conducted as per the American National Standards Institute (ANSI) respiratory protection standard. The pass-fail rates were stratified by respirator model and a Kappa statistic was calculated for each to determine effect of model on fit-test outcomes.

We had 619 participants and the aggregate Κ statistic for all respirators was 0.63 which is below the suggested ANSI threshold of 0.70. There was no statistically significant difference in results when stratified by respirator model.

QNFT and QLFT produced different fit-test outcomes for the three respirator models examined. The disagreement in outcomes between the two fit-test methods with our suite of N95 filtering facepiece respirators was approximately 12%. Our findings may benefit other healthcare organizations that use these three respirators.     

In vitro studies of endophytic fungi from Tripterygium wilfordii with anti-proliferative activity on human peripheral blood mononuclear cells

An array of endophytic fungi which habitat in a Chinese medicinal plant, Tripterygium wilfordii Hook. f., (TWHf) were isolated and tested for their suppressive activity on phytohemaglutinin (PHA) stimulated proliferation of human peripheral blood mononuclear cells (PBMC). Out of the 343 isolates, representing 60 different morphotypes, were screened. Amongst the screened fungi, only 15 isolates showed anti-proliferative activity. Ethyl acetate extracts of Pestalotiopsis leucoth?s, Mucor sp. Verticillium sp. or Pestalotiopsis disseminata, in particular, significantly inhibited the proliferation at doses between 0.12 and 500 microg/ml (stimulation index (S.I.) ranges 0.01-0.70) (P < 0.001-0.05). IC50 values of these four fungal extracts were between 0.75-0.80 +/- 0.12 microg/ml. Trypan blue exclusion test and visual examination of cell morphology demonstrate that the anti-proliferative effect of these extracts was not a sequential consequence of their cytotoxicity. Nevertheless, fungal extracts of Acremonium sp. A and C, Pestalotiopsis suffocata, Morphotype sp. 4 and 5 show a much higher cytotoxic effects on PBMC. Our results indicate that some fungal extracts contain significant amount of immunomodulatory principles.     

Surveillance for Highly Pathogenic Avian Influenza Virus in Wild Birds during Outbreaks in Domestic Poultry,Minnesota, 2015

In 2015, a major outbreak of highly pathogenic avian influenza virus (HPAIV) infection devastated poultry facilities in Minnesota, USA. To understand the potential role of wild birds, we tested 3,139 waterfowl fecal samples and 104 sick and dead birds during March 9–June 4, 2015. HPAIV was isolated from a Cooper’s hawk but not from waterfowl fecal samples.     

百令胶囊治疗早期糖尿病肾病的系统评价

目的系统评价百令胶囊治疗早期糖尿病肾病（DN）的有效性和安全性。方法采用Cochrane系统评价方法,计算机检索MED-LINE,VIP,CNKI,万方数据库和PubMed数据库。按纳入和排除标准由2名评价者独立选择试验、提取资料、交叉核对并进行方法学质量评估,采用RevMan5．0软件进行Meta分析。结果共纳入16个研究,包括1035例患者。Meta分析结果显示,尿微量白蛋白排泄率（UAER）[WMD=-25．49,95％CI（-33．42,-18．47）,P〈0．00001]．24h尿蛋白定量[WMD=-0．07,95％c,（-0．12,-0．03）,P=0．001]、C反应蛋白（CRP）[WMD=-1．29,95％CI（-1．72,-0．86）,P〈0．00001],白令胶囊治疗组均优于常规治疗组;仅有7个研究提及百令胶囊治疗期间有无不良反应或毒副作用,均未见严重不良反应事件。结论系统评价结果初步显示,百令胶囊可以降低早期糖尿病肾病患者的UAER、24h尿蛋白定量、CRP相对安全,值得临床推广。