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排序方式: 共有1241条查询结果,搜索用时 31 毫秒
991.
992.
An HMG-CoA reductase inhibitor, cerivastatin, suppresses growth of macrophages expressing matrix metalloproteinases and tissue factor in vivo and in vitro 总被引:36,自引:0,他引:36
Aikawa M Rabkin E Sugiyama S Voglic SJ Fukumoto Y Furukawa Y Shiomi M Schoen FJ Libby P 《Circulation》2001,103(2):276-283
BACKGROUND: Unstable atherosclerotic plaques that cause acute coronary events usually contain abundant macrophages expressing matrix metalloproteinases (MMPs) and tissue factor (TF), molecules that probably contribute to plaque rupture and subsequent thrombus formation. Lipid lowering with HMG-CoA reductase inhibitors reduces acute coronary events. METHODS AND RESULTS: To test whether lipid lowering with an HMG-CoA reductase inhibitor retards macrophage accumulation in rabbit atheroma, we administered cerivastatin to immature Watanabe heritable hyperlipidemic rabbits (cerivastatin group, n=10, cerivastatin 0.6 mg x kg(-1) x d(-1); control group, n=9, saline 0.6 mL x kg(-1) x d(-1)) for 32 weeks and measured macrophage accumulation and expression of MMPs and TF. Serum cholesterol levels after 32 weeks were 809+/-40 mg/dL (control group) and 481+/-24 mg/dL (treated group). Cerivastatin diminished accumulation of macrophages in aortic atheroma. Macrophage expression of MMP-1, MMP-3, MMP-9, and TF also decreased with cerivastatin treatment. Cerivastatin reduced the number of macrophages expressing histone mRNA (a sensitive marker of cell proliferation) detected by in situ hybridization but did not alter macrophages bearing a marker of death (TUNEL staining). Cerivastatin treatment (>or=0.01 micromol/L) also reduced growth, proteolytic activity due to MMP-9, and TF expression in cultured human monocyte/macrophages. CONCLUSIONS: These results suggest that lipid lowering with HMG-CoA reductase inhibitors alters plaque biology by reducing proliferation and activation of macrophages, prominent sources of molecules responsible for plaque instability and thrombogenicity. 相似文献
993.
994.
995.
A 22‐Year Follow‐Up (Range 16 to 23) of Original Subjects with Baseline Alcohol Use Disorders from the Collaborative Study on Genetics of Alcoholism 下载免费PDF全文
Marc A. Schuckit Tom L. Smith George Danko John Kramer Kathleen K. Bucholz Vivia McCutcheon Grace Chan Samuel Kuperman Victor Hesselbrock Danielle M. Dick Michie Hesselbrock Bernice Porjesz Howard J. Edenberg John I. Nureberger Jr. Marcy Gregg Lara Schoen Mari Kawamura Lee Anne Mendoza 《Alcoholism, clinical and experimental research》2018,42(9):1704-1714
996.
Schoen PJ Raghoebar GM Bouma J Reintsema H Burlage FR Roodenburg JL Vissink A 《International journal of oral and maxillofacial surgery》2008,37(1):8-16
The aim of this prospective study was to assess treatment outcome and impact on quality of life of prosthodontic rehabilitation with implant-retained prostheses in head-neck cancer patients. Fifty patients were evaluated by standardized questionnaires and clinical assessment. All received the implants during ablative tumour surgery in native bone in the interforaminal area. About two-thirds of the patients (n=31) needed radiotherapy post-surgery. Both in irradiated and non-irradiated bone two implants were lost 18-24 months after installation. Peri-implant tissues had a healthy appearance. No cases of osteoradionecrosis occurred. In 15 patients no functional implant-retained lower dentures could be made for various reasons. The other 35 patients all functioned well, with an improvement in quality of life. Major improvement was observed in the non-irradiated patients. In the irradiated patients, less improvement in many functional items was observed, while items related to the oral sequelae of radiotherapy did not improve. Similar to the quality-of-life assessments, denture satisfaction was improved and tended to be higher in non-irradiated than irradiated patients. Implant-retained lower dentures can substantially improve the quality of life related to oral functioning and denture satisfaction in head-neck cancer patients. This effect is greater in non-irradiated than irradiated cancer patients. 相似文献
997.
Schoen R Fakler O Metzger MC Weyer N Schmelzeisen R 《International journal of oral and maxillofacial surgery》2008,37(2):111-116
Temporomandibular joint (TMJ) function was evaluated following endoscope-assisted transoral open reduction and miniplate fixation of displaced bilateral condylar mandibular fractures. The transoral treatment of bilateral condylar fractures was performed in 13 patients from May 2000 to December 2004. Eleven of the 13 patients had additional mandibular fractures. Out of 26 fractures of the condylar process, 11 were located at the condylar neck and 15 were subcondylar. One, 6 and 12 months after surgery TMJ function was evaluated. Anatomic reduction was achieved using an endoscope-assisted transoral approach even when the condylar fragment was displaced medially and in fractures with comminution. Good TMJ function was noted 6 and 12 months after surgery. Mouth opening was measured to be more than 40 mm without deviation. Postoperative range of motion with a satisfying lateral excursion was found. Early rehabilitation and pre-injury TMJ function was achieved following minimally invasive anatomic fracture reduction. 相似文献
998.
Giuseppe Valenza Biju Joseph Johannes Elias Heike Claus Anett Oesterlein Kathrin Engelhardt Doris Turnwald Matthias Frosch Marianne Abele-Horn Christoph Schoen 《Antimicrobial agents and chemotherapy》2010,54(8):3493-3497
A total of 489 clinical isolates of Pseudomonas aeruginosa was investigated for metallo-β-lactamase (MBL) production. Molecular analysis detected a blaVIM-1 gene in the chromosome of one isolate and a blaVIM-2 gene carried on the plasmid in seven isolates. Moreover, we showed that an initial screening by combined susceptibility testing of imipenem and ceftazidime followed by a confirmatory EDTA combination disk test represents a valid alternative to the molecular investigation of MBL genes, making MBL detection possible in routine diagnostic laboratories.Metallo-β-lactamase (MBL)-producing Gram-negative bacteria are an increasing public health problem worldwide because of their resistance to all β-lactams except aztreonam (3). MBL genes are typically part of an integron and are either carried on transferable plasmids or are part of the bacterial chromosome (28). The most common transferable MBL families include the VIM-, IMP-, GIM-, SPM-, and SIM-type enzymes which have been detected primarily in Pseudomonas aeruginosa but were also found in other Gram-negative bacteria, including nonfermenters and members of the family Enterobacteriaceae (22). Recently, two new subgroups of MBLs, designated NDM-1 and DIM-1, were identified in a clinical isolate of Klebsiella pneumoniae in India and in a clinical isolate of Pseudomonas stutzeri in the Netherlands, respectively (21, 31).In most studies, reduced susceptibility to imipenem has been adopted as the sole criterion for further phenotypic or molecular investigations in order to detect MBLs (11, 19, 20, 23). However, this criterion seems to be suboptimal, as it does not allow exclusion of isolates characterized by the loss of the OprD porin, the most common mechanism of resistance to imipenem in P. aeruginosa (14, 22). Moreover, several phenotypic tests for detecting MBLs, such as the MBL Etest (20, 25), EDTA combination disk test (20, 25, 30), EDTA disk synergy test (10), and imipenem lysate MBL assay (27), have been developed and evaluated. However, the performance of each of these tests seems to be strongly affected by the local rate of MBL-producing isolates.In Germany, VIM-, and GIM-type enzymes in P. aeruginosa isolates have already been detected (1, 8, 26). Recently, Elias et al. described a nosocomial outbreak caused by a blaVIM-2-positive P. aeruginosa in patients of the Department of Urology of the university hospital of the University of Würzburg, Würzburg, Germany, between November and December 2007 (4). However, to the best of our knowledge, no systematic surveys of the occurrence of MBLs in clinical isolates of P. aeruginosa have been conducted in Germany so far.Accordingly, this study was designed with the following aims: (i) to develop improved screening criteria for the detection of MBL-producing P. aeruginosa; (ii) to determine the proportion of MBL-producing isolates in clinical isolates of P. aeruginosa in the university hospital of the University of Würzburg in Germany; (iii) to assess the relatedness of MBL-producing isolates; (iv) to determine the locations of the MBL genes detected; and (v) to evaluate two phenotypic tests as confirmatory tests for the detection of MBL production.Since no standard imipenem MIC breakpoints for MBL producers are available, we first analyzed the MICs of imipenem in 10 well-characterized P. aeruginosa control strains shown previously to produce IMP-, VIM-, GIM-, SIM-, and SPM-type enzymes (Table (Table1).1). Identification to the species level was confirmed using Vitek 2 GN cards (bioMérieux, Nürtingen, Germany). Antimicrobial susceptibility testing was carried out with Vitek 2 AST-N021 and AST-N110 cards (bioMérieux). MICs were interpreted as recommended by the CLSI (2). All MBL-producing positive-control strains were intermediate sensitive or resistant to imipenem (MIC ≥ 8 μg/ml). Subsequently, we investigated 26 consecutive nonreplicate clinical isolates of P. aeruginosa with an imipenem MIC of ≥8 μg/ml for the presence of MBL genes by multiplex PCR as described by Ellington et al. (5). All clinical isolates were collected in our laboratory throughout 2007 before the outbreak at the university hospital of the University of Würzburg, Würzburg, Germany (4), and all isolates were shown by multiplex PCR to be negative for MBL genes. Since the loss of the OprD porin, the most common mechanism of resistance to imipenem in P. aeruginosa, does not confer ceftazidime resistance (15), we analyzed the ceftazidime MICs in the MBL-producing positive-control strains and in the 26 MBL-negative isolates. While all 10 MBL-producing positive-control strains were resistant to ceftazidime (MIC ≥ 32 μg/ml), only 6 of the 26 MBL-negative isolates were resistant to ceftazidime (P < 0.01) (Table (Table1).1). Consequently, we adopted MIC breakpoints for the initial screening of MBL producers of ≥8 μg/ml for imipenem and ≥32 μg/ml for ceftazidime.
Open in a separate windowaTen well-characterized MBL-positive strains (9 P. aeruginosa strains and one Acinetobacter baumanii strain) (control strains) and 26 MBL-negative P. aeruginosa isolates with reduced susceptibility to imipenem (clinical isolates) are compared.bP. aeruginosa strains and isolates are indicated by PA at the beginning of the strain or isolate designation, and P. aeruginosa isolates from patients with cystic fibrosis are indicated by CF after a slash at the end of the isolate designation. One Acinetobacter baumanii (AB) control strain is shown.cThe type of MBL enzyme is given for the control strains that produce MBL. The clinical isolates were MBL negative (−).dAll 10 MBL-producing positive-control strains were resistant to ceftazidime (MIC ≥ 32 mg/ml), but only 6 of the 26 MBL-negative clinical isolates were resistant to ceftazidime (P < 0.01 by Fisher''s exact test).From June 2008 until May 2009, a total of 489 consecutive nonreplicate isolates of P. aeruginosa from diverse clinical specimens were screened for MBL production. Sixty-eight of these isolates (13.9%) showed reduced susceptibility to imipenem (MIC ≥ 8 μg/ml). Adding resistance to ceftazidime (MIC ≥ 32 μg/ml) as an additional screening criterion for MBL production reduced the number of isolates to be consecutively tested by multiplex PCR (5) to 15. Following PCR, sequencing of the purified amplicons (QIAquick PCR purification kit; Qiagen, Hilden, Germany) was performed with an ABI 3130 genetic analyzer (Applied Biosystems, Foster City, CA). Molecular analysis revealed a blaVIM-1 gene in one isolate and a blaVIM-2 gene in seven additional isolates. These results were confirmed by amplification and sequencing of the entire VIM gene of isolates PA500 (blaVIM-1) and PA399 (blaVIM-2) by using the primer pairs VIM-F (5′-GTTATGCCGCACTCACCCCCA-3′)/VIM-R (5′-TGCAACTTCATGTTATGCCG-3′) (29) and VIM2004A/VIM2004B (20). Furthermore, we could demonstrate the association of the MBL genes with a class 1 integron by PCR using the integron-specific primers 5-CS and 3-CS in combination with the MBL-specific primers VIM2004A and VIM2004B (20). The clinical origins and antimicrobial susceptibilities of the MBL-positive isolates are shown in Table Table22.
Open in a separate windowaICU, intensive care unit.bThe type of MBL enzyme is given for the isolates that produce MBL. Some isolates did not produce MBL (−).cAbbreviations for antimicrobial agents: PIP, piperacillin; TZP, piperacillin-tazobactam; CAZ, ceftazidime; FEP, cefepime; ATM, aztreonam; IMP, imipenem; MEM, meropenem; COL, colistin; AMK, amikacin; GEN, gentamicin; TOB, tobramycin; CIP, ciprofloxacin.On the basis of these results, the proportion of isolates producing MBL was 1.6% with regard to all P. aeruginosa isolates investigated and 11.7% with regard to the isolates with reduced susceptibility to imipenem. These data are in accordance with the MBL-producing isolate proportions recently reported for, e.g., Italy and Korea. However, we observed only the presence of the VIM-type MBLs, not the IMP-type MBLs, which are also commonly detected worldwide (11, 23).All P. aeruginosa isolates with reduced susceptibility to imipenem and resistance to ceftazidime were analyzed for genomic relatedness by a randomly amplified polymorphic DNA (RAPD) typing technique using primers 208 and 272 (16). From the banding pattern, a dendrogram using the Ward clustering algorithm was generated based on the Dice coefficients with 0.5% optimization and 0.5% position tolerance for band matching and comparison using the GelComparII software program (Applied Maths, Sint-Martens-Latem, Belgium). RAPD typing with primer 208 revealed that all blaVIM-2-positive isolates clustered together (Fig. (Fig.1).1). The cluster also included the first isolate of the outbreak at the university hospital of the University of Würzburg (PA399) (4). These results were confirmed by RAPD typing with primer 272 (data not shown) and suggest a common clonal origin of all blaVIM-2-positive isolates.Open in a separate windowFIG. 1.Genotypic comparison of imipenem-nonsusceptible and ceftazidime-resistant isolates based on the RAPD profile using primer 208. The isolate designation, presence and type of MBL, and presence (+) or absence (−) of a plasmid in the P. aeruginosa isolate is shown to the right of the RAPD profile. The clusters are shown to the left of the RAPD profile.Plasmid extraction was attempted from all imipenem-nonsusceptible and ceftazidime-resistant isolates by the alkaline lysis method (24). Extracted plasmid DNA was subsequently subjected to 0.7% agarose gel electrophoresis, followed by ethidium bromide staining, which revealed the presence of a plasmid in all blaVIM-2-positive isolates but not in isolate PA500, which therefore carried the blaVIM-1 gene on its chromosome. To further characterize the genetic location of the blaVIM-2 genes by the Southern blot technique, total DNA from all imipenem-nonsusceptible and ceftazidime-resistant isolates was subjected to pulsed-field gel electrophoresis (PFGE) using a modified version of the protocol obtained from the home page of the Health Protection Agency of the United Kingdom (http://www.hpa.org.uk/) and hybridized using digoxigenin (DIG)-labeled probes for blaVIM-2 and 16S rRNA gene. The probes were generated using the DIG-DNA labeling kit (Roche Diagnostics, Mannheim, Germany) with the purified PCR product amplified with the primer pair VIM2004A and VIM2004B (20) for blaVIM-2 and primer pair pc3 and bak for the 16S rRNA gene (7). Hybridization with the blaVIM-2-specific gene probe revealed a band about 160 kb in size in all blaVIM-2-positive isolates, corresponding to a plasmid carrying blaVIM-2. The presence of the plasmid was further confirmed by large-scale preparation of plasmid DNA from isolates PA399 and PA462 using CsCl density gradient ultracentrifugation (24), followed by PFGE of the purified plasmids for size determination.Furthermore, we successfully performed the conjugative transfer of the blaVIM-2 gene from isolate PA462 (MBL positive), which showed meropenem and amikacin MICs of ≥16 and 4 μg/ml, respectively, to isolate PA507 (MBL negative), which showed meropenem and amikacin MICs of 4 and 16 μg/ml, respectively. In detail, bacterial suspensions of both isolates in brain heart infusion (BHI) were adjusted to a McFarland standard of 0.5, and 3 ml of each suspension was mixed together and incubated at 37°C for 2 h without shaking. Transconjugant selection was performed on Mueller-Hinton (MH) agar plates containing 6 μg/ml each of meropenem and amikacin. The transconjugant was positive for blaVIM-2 as revealed by PCR with primers VIM2004A and VIM2004B. Moreover, RAPD typing using primers 208 and 272 and colony morphology on Mueller-Hinton agar revealed that the transconjugant and the MBL-negative isolate PA507 were geno- and phenotypically closer to each other than to isolate PA462, which clearly demonstrated that the plasmid carrying blaVIM-2 was transferred to the MBL-negative isolate PA507. The molecular analyses thus demonstrate the spread of a clone of P. aeruginosa harboring blaVIM-2 as part of a class 1 integron on a large conjugative plasmid in the geographically and temporarily restricted setting of a German university hospital.In addition, all isolates with reduced susceptibility to imipenem and resistance to ceftazidime were also subjected to a phenotypic analysis by MBL Etest (AB Biodisk, Solna, Sweden) and EDTA combination disk test. The EDTA combination disk test was performed as previously described (20) using antibiotic disks (Oxoid, Wesel, Germany) containing 10 μg imipenem alone and in combination with 930 μg EDTA. The MBL Etest correctly identified all MBL-positive isolates but falsely identified six of the seven MBL-negative P. aeruginosa isolates as MBL positive. In contrast, the EDTA disk test was able to discriminate between all MBL-positive and MBL-negative isolates by using a breakpoint of ≥14 mm. Of note, the same test interpreted with a breakpoint of ≥7 mm as suggested by Pitout et al. (20) falsely identified all MBL-negative isolates as MBL positive. These data therefore suggest that the optimal breakpoint may depend on the strain collection studied. An initial screening by combined susceptibility testing of imipenem and ceftazidime, followed by a confirmatory EDTA combination disk test, thus represents a valid and less expensive alternative to the molecular investigation of MBL genes. This aspect is particularly important, as it makes MBL detection possible not only in reference laboratories but also in routine diagnostic microbiology laboratories. 相似文献
TABLE 1.
Comparison of imipenem and ceftazidime MICs in well-characterized MBL-producing positive-control strains and in MBL-negative clinical isolatesaStrain or isolateb | MBL enzymec | Geographic origin | Reference | MIC (μg/ml) | |
---|---|---|---|---|---|
Imipenem | Ceftazidimed | ||||
Control strains | |||||
PA431 | IMP-1 | Turkey | 17 | 8 | ≥64 |
PA552 | IMP-1 | UK | 5 | ≥16 | ≥64 |
PA386 | IMP-13 | Italy | 18 | ≥16 | ≥64 |
PA550 | VIM-1 | UK | 5 | ≥16 | ≥64 |
PA373 | VIM-2 | Italy | 9 | ≥16 | ≥64 |
PA399 | VIM-2 | Germany | 4 | ≥16 | ≥64 |
PA430 | VIM-4 | Hungary | 13 | ≥16 | ≥64 |
PA554 | GIM-1 | Germany | 1 | ≥16 | ≥64 |
AB551 | SIM-1 | Korea | 12 | ≥16 | ≥64 |
PA553 | SPM-1 | Brazil | 6 | ≥16 | ≥64 |
Clinical isolates | |||||
PA339 | − | Germany | This study | ≥16 | 8 |
PA340 | − | Germany | This study | 8 | 4 |
PA341 | − | Germany | This study | ≥16 | ≥64 |
PA342 | − | Germany | This study | ≥16 | 4 |
PA346 | − | Germany | This study | ≥16 | 4 |
PA349 | − | Germany | This study | ≥16 | 8 |
PA350 | − | Germany | This study | ≥16 | 4 |
PA352 | − | Germany | This study | ≥16 | 4 |
PA355 | − | Germany | This study | ≥16 | 4 |
PA356 | − | Germany | This study | ≥16 | 4 |
PA360 | − | Germany | This study | 8 | 16 |
PA361 | − | Germany | This study | ≥16 | ≥64 |
PA362 | − | Germany | This study | 8 | 32 |
PA364 | − | Germany | This study | 8 | 4 |
PA368 | − | Germany | This study | ≥16 | 4 |
PA370 | − | Germany | This study | ≥16 | 8 |
PA376 | − | Germany | This study | ≥16 | 16 |
PA377 | − | Germany | This study | ≥16 | 8 |
PA380 | − | Germany | This study | 8 | 4 |
PA381 | − | Germany | This study | ≥16 | 4 |
PA382 | − | Germany | This study | ≥16 | 4 |
PA395 | − | Germany | This study | ≥16 | ≥64 |
PA734/CF | − | Germany | This study | ≥16 | 4 |
PA736/CF | − | Germany | This study | 8 | ≥64 |
PA758/CF | − | Germany | This study | ≥16 | 4 |
PA774/CF | − | Germany | This study | ≥16 | ≥64 |
TABLE 2.
Epidemiological data and resistance phenotypes of all P. aeruginosa isolates with reduced susceptibility to imipenem and resistance to ceftazidimeIsolate | Specimen | Date of recovery | Warda | MBL enzymeb | MIC (μg/ml)c | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
PIP | TZP | CAZ | FEP | ATM | IMP | MEM | COL | AMK | GEN | TOB | CIP | |||||
MBL-producing isolates | ||||||||||||||||
PA399 | Urine | November 2007 | Urology | VIM-2 | ≥128 | ≥128 | ≥64 | ≥64 | 16 | ≥16 | ≥16 | 1 | 8 | ≥16 | ≥16 | ≥4 |
PA462 | Ascitic fluid | June 2008 | General surgery | VIM-2 | ≥128 | ≥128 | ≥64 | ≥64 | 16 | ≥16 | ≥16 | 1 | 4 | ≥16 | ≥16 | ≥4 |
PA465 | Drainage | July 2008 | General surgery | VIM-2 | ≥128 | 64 | ≥64 | ≥64 | 16 | ≥16 | ≥16 | 2 | 8 | ≥16 | ≤1 | ≥4 |
PA469 | Wound | August 2008 | General surgery | VIM-2 | ≥128 | ≥128 | ≥64 | ≥64 | 16 | ≥16 | ≥16 | 1 | 8 | ≥16 | ≥16 | ≥4 |
PA475 | Wound | September 2008 | General surgery | VIM-2 | ≥128 | ≥128 | ≥64 | ≥64 | 16 | ≥16 | ≥16 | 1 | 4 | ≥16 | ≥16 | ≥4 |
PA477 | Drainage | September 2008 | General surgery | VIM-2 | ≥128 | ≥128 | ≥64 | ≥64 | 16 | ≥16 | ≥16 | 1 | 8 | ≥16 | ≥16 | ≥4 |
PA481 | Urine | October 2008 | Urology | VIM-2 | ≥128 | ≥128 | ≥64 | ≥64 | 16 | ≥16 | ≥16 | 1 | 8 | ≥16 | ≥16 | ≥4 |
PA500 | Tracheal secretion | February 2009 | Surgical ICU | VIM-1 | ≥128 | ≥128 | ≥64 | ≥64 | 4 | ≥16 | ≥16 | 1 | ≤2 | ≥16 | 8 | ≥4 |
PA510 | Tracheal secretion | May 2009 | Medical ICU | VIM-2 | ≥128 | ≥128 | ≥64 | ≥64 | ≥64 | ≥16 | ≥16 | 1 | 4 | ≥16 | ≥16 | ≥4 |
MBL-negative isolates | ||||||||||||||||
PA459 | Tracheal secretion | June 2008 | Surgical ICU | − | ≥128 | ≥128 | 32 | 8 | 16 | ≥16 | 8 | 1 | 2 | 1 | 1 | 0.25 |
PA460 | Wound | June 2008 | General surgery | − | ≥128 | ≥128 | 32 | 16 | 16 | ≥16 | 8 | 1 | 4 | ≥16 | ≥16 | ≥4 |
PA479 | Urine | October 2008 | General surgery | − | ≥128 | ≥128 | ≥64 | ≥64 | 32 | 8 | ≥16 | 1 | 8 | ≥16 | ≥16 | ≥4 |
PA483 | Wound | October 2008 | Surgical ICU | − | ≥128 | ≥128 | ≥64 | 32 | 64 | ≥16 | ≥16 | 1 | 2 | 1 | 1 | 0.25 |
PA494 | Urine | December 2008 | Neurosurgery | − | ≥128 | ≥128 | 32 | 8 | 16 | ≥16 | 8 | 1 | 8 | 8 | 1 | ≥4 |
PA507 | Drainage | April 2009 | Surgical ICU | − | ≥128 | ≥128 | 32 | 16 | 16 | ≥16 | 4 | 1 | 16 | ≥16 | 1 | 0.25 |
PA509 | Wound | May 2009 | Internal medicine | − | ≥128 | ≥128 | 32 | 16 | 8 | ≥16 | ≥16 | 2 | 64 | ≥16 | ≥16 | ≥4 |
999.
1000.