Evaluation of Reduced Susceptibility to Quaternary Ammonium Compounds and Bisbiguanides in Clinical Isolates and Laboratory-Generated Mutants of Staphylococcus aureus

The MICs and minimum bactericidal concentrations (MBCs) for the biocides benzalkonium chloride and chlorhexidine were determined against 1,602 clinical isolates of Staphylococcus aureus. Both compounds showed unimodal MIC and MBC distributions (2 and 4 or 8 mg/liter, respectively) with no apparent subpopulation with reduced susceptibility. To investigate further, all isolates were screened for qac genes, and 39 of these also had the promoter region of the NorA multidrug-resistant (MDR) efflux pump sequenced. The presence of qacA, qacB, qacC, and qacG genes increased the mode MIC, but not MBC, to benzalkonium chloride, while only qacA and qacB increased the chlorhexidine mode MIC. Isolates with a wild-type norA promoter or mutations in the norA promoter had similar biocide MIC distributions; notably, not all clinical isolates with norA mutations were resistant to fluoroquinolones. In vitro efflux mutants could be readily selected with ethidium bromide and acriflavine. Multiple passages were necessary to select mutants with biocides, but these mutants showed phenotypes comparable to those of mutants selected by dyes. All mutants showed changes in the promoter region of norA, but these were distinct from this region of the clinical isolates. Still, none of the in vitro mutants displayed fitness defects in a killing assay in Galleria mellonella larvae. In conclusion, our data provide an in-depth comparative overview on efflux in S. aureus mutants and clinical isolates, showing also that plasmid-encoded efflux pumps did not affect bactericidal activity of biocides. In addition, current in vitro tests appear not to be suitable for predicting levels of resistance that are clinically relevant.     

Impact of Xuezhikang on coronary events in hypertensive patients with previous myocardial infarction from the China Coronary Secondary Prevention Study (CCSPS)

Abstract

Background. The lowering of cholesterol concentrations in individuals at high risk for cardiovascular disease improves clinical outcome. Xuezhikang has a marked impact on lipids.

Methods. In this randomized, double-blinded, placebo-controlled, parallel-group clinical trial, a total of 2704 hypertensive patients with previous myocardial infarction (MI) were assigned either to placebo (n = 1341) or to Xuezhikang (0.6 g twice daily, n = 1363) for an average of 4.5 years. The primary end-point was recurrent coronary events; the secondary end-point was all-cause mortality and other clinical events, including adverse effects.

Results. There were no differences between the Xuezhikang and placebo group in base-line characteristics. However, Xuezhikang treatment reduced the incidence of coronary events by 43.0% (P = 0.02), deaths from coronary heart disease (CHD) by 30.0% (P < 0.01), and all-cause mortality by 35.8% (P = 0.001).

Conclusions. This study, for the first time, demonstrated that long-term Xuezhikang therapy resulted in significant reduction in cardiovascular events and death in Chinese hypertensive patients with previous MI in a safe manner.     

~(99m)锝腮腺动态显像对舍格伦综合征的诊断价值

目的 探讨＾９９ｍ锝腮腺动态显像对诊断舍格伦征的价值。方法 应用＾９９ｍ锝对临床诊断为舍格伦综合征的５２例患者进行腮腺动态显像,将所得的结果应用计算机ＲＯＩ程序进行定量分析和动态曲线分析,结果 腮腺外形较正常大者４６例（８８．４％）肿大腮腺轮廓清晰２８例（５３．８５％）轮廓模糊１８例（３４．６２％）腮腺功能正常７例（１３．４６％）轻度受损１５例（２８．８４％）中８度受损１７例（３２．６９％）,重度     

CT urography: definition,indications and techniques. A guideline for clinical practice

The aim was to develop clinical guidelines for multidetector computed tomography urography (CTU) by a group of experts from the European Society of Urogenital Radiology (ESUR). Peer-reviewed papers and reviews were systematically scrutinized. A summary document was produced and discussed at the ESUR 2006 and ECR 2007 meetings with the goal to reach consensus. True evidence-based guidelines could not be formulated, but expert guidelines on indications and CTU examination technique were produced. CTU is justified as a first-line test for patients with macroscopic haematuria, at high-risk for urothelial cancer. Otherwise, CTU may be used as a problem-solving examination. A differential approach using a one-, two- or three-phase protocol is proposed, whereby the clinical indication and the patient population will determine which CTU protocol is employed. Either a combined nephrographic-excretory phase following a split-bolus intravenous injection of contrast medium, or separate nephrographic and excretory phases following a single-bolus injection can be used. Lower dose (CTDIvol 5–6 mGy) is used for benign conditions and normal dose (CTDIvol 9–12 mGy) for potential malignant disease. A low-dose (CTDIvol 2–3 mGy) unenhanced series can be added on indication. The expert-based CTU guidelines provide recommendations to optimize techniques and to unify the radiologist’s approach to CTU. Electronic Supplementary Material The online version of this article (doi:) contains supplementary material, which is available to authorized users. ESUR:     

原发性肝癌切除术后发生肝功能代偿不全的临床研究

目的: 探讨了解肝部分切除术后出现肝功能不全的可能原因. 方法: 将63例原发性肝癌患者分成3组,比较分析各组的手术后生存时间与生存率、术后复发率、术前、术后的主要肝功能指标,术后一年内出现肝功能不全的原因与频率,以及死亡患者的死亡原因与时间等. 结果: 平均随访时间为(25±21.3)个月,各组生存率无显著性差异,总复发率为56%(35/63),平均复发时间为17个月;术后死于复发癌的时间为(22±12.3)个月,死于肝功能不全的时间为(4.8±3.7)个月,术前肝功能储备差者,术后易发生代偿不全,术后早期死亡者大多由肝功能不全所致. 结论: 对原发性肝癌病人行肝部分切除术时,要充分了解肝功能储备,术后早期积极给予保肝治疗.     

近端胆管癌的外科治疗

目的 探讨近端胆管癌的外科治疗及疗效。方法 57例近端胆管癌患者中21例行外科手术治疗,36例行非手术外引流治疗。结果21例手术治疗患者中17例存活14月以上,36例行鼻胆管引流或内置管引流术患者均在8月内死亡。结论 外科手术治疗近端胆管癌疗效明显优于鼻胆管引流术（ENBD）或内置管引流术（EHBD）胆管内外引流。     

粉防己碱对瘢痕成纤维细胞活性功能的影响

目的　观察粉防己碱对体外培养的巨噬细胞介质介导瘢痕成纤维细胞活性功能的调控作用 ,并探讨其在瘢痕防治中的意义。方法　取 5例手术切除的人增生性瘢痕组织标本行瘢痕成纤维细胞体外培养 ,于传代培养至第 4代的成纤维细胞 (5× 10 4)中分组加入巨噬细胞介质、粉防己碱继续培养 ,然后分别用3 H TdR和3 H 脯氨酸脉冲标记 ,放射性核素液闪烁仪定量检测各组3 H TdR和3 H 脯氨酸掺入值。并采用三维培养方法测定体外模拟瘢痕样组织的收缩指数变化。结果　粉防己碱 3mg/L不抑制细胞DNA合成时 ,即可明显减少瘢痕成纤维细胞 3 H 脯氨酸掺入值 ,由对照组的 94 5± 191减少至6 82± 2 0 5 (P <0 .0 5 ) ;并能显著降低巨噬细胞介质介导的瘢痕成纤维细胞3 H TdR掺入值和3 H 脯氨酸掺入值 ,由单纯介质组的 2 75 6± 2 4 4、1384± 2 93分别降低至 194 8± 2 82、10 34± 14 2 (均P <0 .0 1)。粉防己碱 1mg/L即可降低体外瘢痕样组织的收缩指数 (P <0 .0 1)。结论　粉防己碱对体外培养的巨噬细胞介质介导瘢痕成纤维细胞增殖、胶原合成以及收缩三方面具有抑制效应 ,可望在增生性瘢痕的防治中发挥重要作用。