<Emphasis Type="Italic">Staphylococcus aureus</Emphasis> carriage at admission predicts early-onset pneumonia after burn trauma

Early-onset pneumonia (EOP) is frequent after burn trauma, increasing morbidity in the critical resuscitation phase, which may preclude early aggressive management of burn wounds. Currently, however, preemptive treatment is not recommended. The aim of this study was to identify predictive factors for EOP that may justify early empirical antibiotic treatment. Data for all burn patients requiring ≥4 h mechanical ventilation (MV) who were admitted between January 2001 and October 2012 were extracted from the hospital’s computerized information system. We reviewed EOP episodes (≤7 days) among patients who underwent endotracheal aspiration (ETA) within 5 days after admission. Univariate and multivariate analyses were performed to identify independent factors associated with EOP. Logistic regression was used to identify factors predicting EOP development. During the study period, 396 burn patients were admitted. ETA was performed within 5 days in 204/290 patients receiving ≥4 h MV. One hundred and eight patients developed EOP; 47 cases were caused by Staphylococcus aureus, 37 by Haemophilus influenzae, and 23 by Streptococcus pneumoniae. Among the 33 patients showing S. aureus positivity on ETA samples, 16 (48.5 %) developed S. aureus EOP. Among the 156?S. aureus non-carriers, 16 (10.2 %) developed EOP. Staphylococcus aureus carriage independently predicted EOP (p?<?0.0001). We identified S. aureus carriage as an independent and strong predictor of EOP. As rapid point-of-care testing for S. aureus is readily available, we recommend testing of all patients at admission for burn trauma and the consideration of early preemptive treatment in all positive patients. Further studies are needed to evaluate this new strategy.     

A smart fluorescent biosensor for the highly sensitive detection of BRCA1 based on a 3D DNA walker and ESDR cascade amplification

Nucleic acid analysis plays an important role in the diagnosis of diseases. There is a continuous demand to develop rapid and sensitive methods for the specific detection of nucleic acids. Herein, we constructed a highly sensitive and rapid fluorescent biosensor for the detection of BRCA1 by coupling a 3D DNA walker machine with spontaneous entropy-driven strand displacement reactions (ESDRs). In this study, the 3D DNA walker machine was well activated by the target DNA; this resulted in the cyclic utilization of the target DNA and the release of intermediate DNAs. Subsequently, the free intermediate DNAs triggered the circulation process of ESDRs with the help of the assistant probe A, leading to a significant enhancement of the fluorescence intensity. Due to the robust execution of the 3D DNA walker machine and highly efficient amplification capability of ESDRs, the developed biosensing method shows a wide linear range from 0.1 pM to 10 nM with the detection limit as low as 41.44 fM (S/N = 3). Moreover, the constructed biosensor displays superior specificity and has been applied to monitor BRCA1 in complex matrices. Thus, this elaborated cascade amplification biosensing strategy provides a potential platform for the bioassays of nucleic acids and the clinical diagnosis of diseases.

Nucleic acid analysis plays an important role in the diagnosis of diseases.     

The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta-analysis

Purpose

Studies have shown that tranexamic acid (TXA) reduces blood loss and transfusion need in patients undergoing total knee arthroplasty (TKA). However, no single study has been large enough to definitively determine whether the drug is safe and effective. We report a systematic review and meta-analysis of randomised controlled trials evaluating the efficacy and safety of TXA in reducing blood loss and transfusion in TKA.

Methods

A comprehensive literature search was done in Cochrane Library, MEDLINE, EMBASE, and CNKI. Two reviewers independently identified the eligible studies, assessed their methodological quality, and extracted data. The data were evaluated using the generic evaluation tool designed by the Cochrane Bone, Joint and Muscle Trauma Group. The relevant data were analyzed using RevMan 5.0.

Results

Fifteen randomized controlled trials involving 842 patients were included. The use of TXA reduced total blood loss by a mean of 487?ml [95% confidence interval (CI) ?629 to ?344], intra-operative blood loss by a mean of 127?ml (95% CI ?313–59), and post-operative blood loss by a mean of 245?ml (95% CI ?410 to ?80). TXA led to a significant reduction in the proportion of patients requiring blood transfusion (risk difference ?0.4). There were no significant differences in deep-vein thrombosis (DVT), pulmonary embolism, or other complications among the study groups.

Conclusion

Meta-analysis indicates that TXA may reduce post-operative, total blood loss and transfusion in patients undergoing TKA. TXA led to a significant reduction in the proportion of patients requiring blood transfusion.

Level of evidence

Therapeutic study (Systematic review of Level I studies with inconsistent results), Level II.     

Neoadjuvant Treatment of Duodenal Adenocarcinoma: A Rescue Strategy

Aim  

To evaluate the role of neoadjuvant chemoradiation therapy and rescue surgery in the management of unresectable or recurrent duodenal adenocarcinoma.     

A whole-genome linkage scan suggests several genomic regions potentially containing quantitative trait Loci for osteoporosis

Osteoporosis is an important health problem, particularly in the elderly women. Bone mineral density (BMD) is a major determinant of osteoporosis. For a sample of 53 pedigrees that contain 1249 sibling pairs, 1098 grandparent-grandchildren pairs, and 2589 first cousin pairs, we performed a whole- genome linkage scan using 380 microsatellite markers to identify genomic regions that may contain quantitative trait loci (QTL) of BMD. Each pedigree was ascertained through a proband with BMD values belonging to the bottom 10% of the population. We conducted two-point and multipoint linkage analyses. Several potentially important genomic regions were suggested. For example, the genomic region near the marker D10S1651 may contain a QTL for hip BMD variation (with two-point analysis LOD score of 1.97 and multipoint analysis LOD score of 2.29). The genomic regions near the markers D4S413 and D12S1723 may contain QTLs for spine BMD variation (with two-point analysis LOD score of 2.12 and 2.17 and multipoint analysis LOD score of 3.08 and 2.96, respectively). The genomic regions identified in this and some earlier reports are compared for exploration in extension studies with larger samples and/or denser markers for confirmation and fine mapping to eventually identify major functional genes involved in osteoporosis.     

A preoperative nomogram predicts prognosis of up front resectable patients with pancreatic head cancer and suspected venous invasion

Background

Pancreatic head adenocarcinoma is commonly diagnosed at an advanced stage when adjacent vascular invasion is present. This study aimed to establish a preoperative prognostic nomogram for patients who underwent attempted curative resectional surgery for pancreatic head cancer with suspected peripancreatic venous invasion.

艾曲波帕治疗儿童造血干细胞移植后血小板减少症24例分析

目的评价艾曲波帕治疗儿童造血干细胞移植(HSCT)后血小板减少症的疗效与安全性。方法回顾性分析2018年8月1日至2019年4月1日于中山大学孙逸仙纪念医院儿科接受HSCT后发生血小板减少症并采用艾曲波帕治疗的24例患儿的临床资料,评估治疗有效率及不良反应,根据造血干细胞来源分为脐带血组和外周干细胞组,根据疾病类型分为恶性病组和非恶性病组,分析各组间临床疗效。组间比较采用秩和检验。结果 24例患儿中男15例、女9例,艾曲波帕用药时的年龄7.7(2.6~13.7)岁,接受艾曲波帕治疗的时间为移植后第27.5(8.0~125.0) d,使用后完全有效的时间为23.5(6.0~83.0) d,用药疗程为36.5(8.0~90.0) d,艾曲波帕总剂量为1 400(200~5 900)mg,完全有效率92%(22/24),未发生艾曲波帕相关不良反应。脐带血干细胞移植(16例)的患儿使用艾曲波帕的疗程及总剂量均明显低于外周干细胞移植组(8例)[24.5(8.0~81.0)比65.5(35.0~90.0)d,900.0(200.0~3 850.0)比2 862.5 (1 175.0~5 900.0) mg,Z=-3.004、-2.604,P=0.002、0.007],而达到完全有效的时间及停药2周后血小板计数、随访终点血小板计数的差异均无统计学意义(均P>0.05)。与恶性病患儿(12例)相比,非恶性病患儿(12例)用药后至获得完全有效的时间、用药疗程、总剂量及停药2周后血小板计数、随访终点血小板计数的差异均无统计学意义(均P>0.05)。结论艾曲波帕用于儿童HSCT后血小板减少症有一定疗效,安全性高,尤其在脐带血移植中可能更有优势。     

Adjunctive radiofrequency ablation of metastatic neuroendocrine cancer to the liver complements surgical resection

Background:

Resection of liver metastases from neuroendocrine cancer (NEC) prolongs survival and provides durable symptom relief. Not all hepatic lesions are amenable to resection, particularly when there is multifocal involvement. In this study, it was hypothesized that ablation of concomitant non-resectable NEC liver metastases is safe and salvages patients who would not have been selected for cytoreductive surgery.

Methods:

Patients who underwent adjuvant ablation of NEC liver metastases between 1995 and 2008 were reviewed. NEC was classified by patient and tumour characteristics. Regression and Kaplan–Meier models were used to compare variables and generate survival curves.

Results:

Ninety-four patients underwent hepatic resection and intra-operative ablation of metastatic NEC. The median number of lesions ablated was 3, and median size was 1.4 cm. One abscess occurred at an ablation site. Local recurrence was detected in four patients (3.8%). Overall survival was 80% and 59% at 5 and 10 years. Age, gender, tumour type, grade, primary site and need for repeat ablation had no significant association with survival. The Ki67 proliferative index was a significant predictor of decreased survival. Symptom-free survival was 34% at 3 years and 16% at 5 years, independent of the tumour grade.

Conclusion:

Concurrent ablation of NEC metastases to the liver not amenable to resection is safe and increases the candidacy of patients for cytoreductive surgery. Ablation performed intra-operatively and repeated post-operatively as needed provides significant symptom control regardless of the tumour grade.     

裂隙灯致视网膜损伤的病理学观察

作者用国产裂隙灯对1只恒河猴双眼黄斑周围视网膜8个部位进行随机持续光照。视网膜照度为226.8mW/cm~2。照射时间分别为105,150min。通过光镜、电镜对光照后即刻到1mo的病灶区视网膜进行观察。光照性视网膜病变主要表现为光感受器和RPE细胞损害,脉络膜血管有大量白细胞渗出。裂隙灯致视网膜损伤主要是光化学反应造成,同时有光凝及炎症反应参与。并提出节省动物和实验时间,避免个体差异的多部位病理取材方法。     

半相合骨髓移植3例的护理

目的:探讨和总结利用半相合骨髓移植治疗白血病患者的护理.方法:根据半相合骨髓移植的特点和风险性,进行移植前患者的准备,层流室的洁净工作以及骨髓回输前、后预防感染,并发症的观察和护理.结果:3例患者中,1例死于移植物抗宿主病(GVHD)、多脏器功能衰竭.2例获得成功,目前已经分别无病生存7个月和1年之久.结论:积极有效的护理措施是半相合骨髓移植成功的关键因素之一.