综合ICU呼吸机相关性肺炎病原菌分布及耐药性研究

目的：分析综合重症监护病房（IC U ）呼吸机相关性肺炎病原菌的分布及耐药特性,为临床抗菌药物的合理应用提供依据。方法对解放军306医院综合IC U病房2012年1～12月进行机械通气大于48 h的122例患者进行回顾性分析,统计并分析呼吸机相关性肺炎病原菌分布特点及其耐药性。结果122例机械通气患者确诊为呼吸机相关性肺炎55例,发病率为45．08％。共检出病原菌122株,其中革兰阴性菌78株（63．93％）,前3位依次为鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌,其中4株肺炎克雷伯菌为产超广谱β内酰胺酶（产ESBL ）。革兰阳性菌19株（15．57％）,主要为金黄色葡萄球菌,检出1株耐万古霉素菌株;真菌25株（20．49％）,主要为白色念珠菌。革兰阴性菌对氨苄西林、环丙沙星、亚胺培南、头孢曲松、优立新耐药明显。与不产ESBL菌株相比,产ESBL肺炎克雷伯菌对绝大多数常用抗菌药物耐药,而对亚胺培南和哌拉西林/他巴唑相对敏感。结论该院综合IC U呼吸机相关性肺炎的主要病原菌为革兰阴性菌,分析其耐药特性可为临床经验性治疗呼吸机相关性肺炎及合理使用抗菌药物提供依据。     

Monitoring transfusionist practices: a strategy for improving transfusion safety

BACKGROUND: Data from New York State indicate that about 1 of every 33,000 red cell units transfused is ABO-incompatible with the recipient. National application of these data suggests that as many as 360 ABO-incompatible whole blood and red cell transfusions might occur annually in the United States. Phlebotomy and blood bank laboratory errors cause some of these ABO-incompatible transfusions, but the greatest number result either partially or solely from the failure of transfusionists to identify properly either a patient or the blood component a patient receives. STUDY DESIGN AND METHODS: A quality assessment/quality improvement (QA/QI), process is described that allowed for the direct oversight (monitoring) of transfusionists' practices and for the assessment of institutional policies for blood administration. RESULTS: At the beginning of the QA/QI process, monitoring of blood administration practices revealed that a variance from institutional blood administration policy occurred during 50 percent of blood and component transfusions. As a result of the QA/QI process, the percentage of transfusions with an associated variance from institutional policy dropped to nearly zero. CONCLUSION: The QA/QI process described in this report, or one similar to it, could improve transfusion safety and serve as a model for increased involvement by transfusion service medical directors in the oversight of transfusionists' practices.     

Safety and efficacy of liraglutide in patients with type 2 diabetes with elevated liver enzymes: individual patient data meta-analysis of the LEAD programme

BackgroundFatty liver disease has reached epidemic proportions in type 2 diabetes. Glucagon-like peptide-1 (GLP-1) analogues are licensed for treatment of type 2 diabetes, yet little data exist on efficacy and safety in liver injury. We aimed to assess the safety and efficacy of 26 weeks' liraglutide on liver function compared with an active placebo.MethodsIndividual patient data meta-analysis was done with patient level data combined from six 26-week, phase 3, double-blind randomised controlled trials on type 2 diabetes, which comprise the Liraglutide Effect and Action in Diabetes (LEAD) programme. In addition, the LEAD-2 sub-study was analysed to assess the effect on CT-measured hepatic steatosis.FindingsOf 4442 patients analysed, 2241 (50·8%) had an abnormal alanine aminotransferase (ALT) at baseline (mean 33·8 IU/L [SD 14·9] in female participants; 47·3 [18·3] in male participants). Liraglutide 1·8 mg reduced ALT in these patients compared with placebo (?8·20 vs ?5·01 IU/L, p=0·003), and was dose dependent (no significant differences vs placebo with liraglutide 0·6 or 1·2 mg). This effect was lost after adjustment for liraglutide's effect on reduction of weight (corrected mean ALT difference vs placebo ?1·41 IU/L, p=0·21) and HbA1c (corrected mean ALT difference vs placebo 0·57 IU/L, p=0·63). Adverse effects with 1·8 mg liraglutide were similar between patients with and without baseline abnormal ALT. In the LEAD-2 sub-study, liraglutide 1·8 mg (26 weeks) improved hepatic steatosis (CT-measured liver:spleen attenuation ratio) from baseline (0·10, p=0·001) and showed a trend towards improvement compared with placebo (0.10 vs 0·00, p=0·07).Interpretation26 weeks of liraglutide (1·8 mg) is safe, well tolerated, and improves liver enzymes compared with placebo in patients with type 2 diabetes.FundingWellcome Trust.     

Early and late components of error monitoring in violent offenders with psychopathy

BACKGROUND: One of the most recognizable features of psychopathy is the reduced ability to successfully learn and adapt overt behavior. This might be due to deficient processing of error information indicating the need to adapt controlled behavior. METHODS: Event-related potentials (ERPs) and behavioral components of error-monitoring processes were investigated in 16 individuals with psychopathy and in 18 healthy subjects. A letter version of the Eriksen flanker task was used in two conditions. The first condition (normal condition) required participants to press one of two buttons depending on the identity of the target stimulus. The second condition (signaling condition) required them to signal each time they had committed an error by making a second press on a signaling button. Early stages of error monitoring were investigated by using the error-related negativity (ERN/Ne) and post-error slowing as indexes. Later stages were explored by examining the error positivity (Pe) and signaling rates. RESULTS: Both groups showed similar ERN amplitudes and amounts of post-error slowing. The psychopathic group exhibited both reduced Pe amplitudes and diminished error-signaling rates compared with the control group. CONCLUSIONS: Individuals with psychopathy show intact early error processing and automatic behavioral adaptation but have deficits in later stages of error processing and controlled behavioral adaptation. This is an indication that individuals with psychopathy are unable to effectively use error information to change their behavior adequately.     

Polymorphonuclear leucocyte transfusion in neonatal septicaemia

In one neonatal intensive care unit during a 15 month period 6 infants developed septicaemia which was resistant to antibiotic treatment. The infants' mean gestational age and birthweight were 32.7 weeks and 1519 g respectively. Intravenous infusions of polymorphonuclear leucocytes were given. Three infants died and the remainder survived without complications. No side effects of the treatment were identified.     

能谱CT虚拟平扫在肾癌中的应用

目的：探讨能谱CT虚拟平扫(VNC)替代常规平扫在肾癌中的临床应用价值。方法回顾分析32例经病理证实为肾癌的患者影像资料,均行能谱CT常规平扫及动脉期、静脉期能谱成像(GSI),采用MSI软件生成动脉期VNC和静脉期VNC图像。分别测量3组图像(常规平扫、动脉期VNC、静脉期VNC)肾脏病灶的CT值、病灶-正常肾脏的对比噪声比(CNR),同层面病灶的长径、橫径,采用单因素方差分析;由2位放射科医师对3组图像分别行5分制图像质量主观评分,3分制影像学征象主观评分,对2位医师评价结果的一致性行Kappa 检验,对3组图像的图像质量主观评分行单因素方差分析。结果2位医师对3组图像评价结果的一致性较好(Kappa 值均>0.700);3组图像间图像质量主观评分无统计学差异(P>0.05);影像学征象主观评分动脉期 VNC为2.88±0.34,静脉期VNC为2.84±0.37,均可接受。3组图像的CNR分别为0.52±0.11、0.72±0.16、0.69±0.12,动脉期VNC、静脉期 VNC的对比噪声比(CNR)均高于常规平扫,有统计学差异(P<0.05)。3组图像同层面病灶的长径和横径无统计学差异(P>0.05)。3组图像肾脏病灶的CT值分别为(30.04±4.09)HU、(32.69±4.07)HU、(32.56±3.52)HU,有统计学差异(P<0.05),常规平扫病灶的CT值低于动脉期 VNC和静脉期 VNC,但差值均在5 HU内。结论在肾癌检查中 VNC能替代常规平扫,可减少患者的扫描次数,降低辐射剂量。     

C型套管针辅助胸腔置管与胸腔穿刺术治疗结核性胸腔积液的临床对比研究

2±7.2)天,住院时间(13.2±6.4)天vs(23.6±4.8)天(P＜0.05,＜0.01).结论 与常规胸穿术比较,C型套管针辅助胸腔内置入细胃管治疗结核性胸腔积液方法更加简单、安全、有效.