远航期间任务人员晕船反应调查及原因分析

目的:研究和平方舟医院船上任务人员在远航期间晕船反应发生情况,分析晕船反应发生的原因,为今后医院船合理配置任务人员及降低任务人员晕船反应发生率提供参考依据。方法:根据自愿原则,采用自制问卷对和平方舟医院船上260名任务人员进行问卷调查,问卷内容主要包括两部分,第一部分基本情况调查,包括性别、年龄、体质量、吸烟史等;第二部分影响晕船反应发生的因素调查,包括出海次数、人员类别、住舱所在甲板位置、登船前是否每日进行体育锻炼、登船后是否每日进行体育锻炼等信息。回收有效问卷251份。采用SPSS 19.0统计软件及Empower Stats软件对数据进行统计分析。结果:单因素分析发现晕船反应发生与性别、体质量、是否抽烟、既往是否执行过出海任务、住舱所在甲板位置、人员类别之间明显相关( P<0.05)。多元回归分析表明,女性及既往未执行过出海任务是晕船反应发生的危险因素( P<0.05)。阈值饱和效应分析显示,从第2个航段开始,每经历1个航段,任务人员晕船反应发生率降低0.51%。 结论:医院船在配置任务人员时应综合评估任务人员基本情况,在安排住舱位置时,应将晕船人员尽量安排在靠近船体中部底层。任务人员平时应注重身体锻炼,保持营养摄入平衡,增强抗晕船适应性训练。     

不同剂量叶酸联合维生素B12干预对高Hcy急性心肌梗死患者预后的影响

目的：探讨不同剂量叶酸联合维生素B12干预对高同型半胱氨酸（HHcy）急性心肌梗死患者预后的影响。方法：445例HHcy急性心肌梗死患者按照治疗方法分为观察组（n=223）和对照组（n=222）。比较两组患者治疗前后血清Hcy水平,分析影响HHcy心肌梗死患者发生主要不良心血管事件（MACE）的相关因素。结果：治疗后两组患者血清Hcy水平均下降,观察组下降幅度高于对照组（P<0.05）。治疗后观察组2a MACE发生率明显低于对照组（9.87%vs 21.62%,P<0.05）。Cox单因素及多因素分析显示年龄、糖尿病、LDL-C、Hcy、治疗方式与HHcy急性心肌梗死患者治疗后发生MACE密切相关。结论：叶酸联合维生素B12干预能够降低HHcy急性心肌梗死患者MACE的发生率,且叶酸剂量15 mg·d^-1效果最佳。     

影响儿童结核性脑膜炎患者近期预后的相关因素分析

目的 探讨影响儿童结核性脑膜炎(tuberculosis meningitis,TBM)近期预后的相关因素.方法 采用回顾性分析的方法,收集西安市结核病胸部肿瘤医院2008年1月1日至2012年12月31日收治的83例TBM患儿临床资料.近期预后良好者53例(63.9％),预后不好者30例(36.1％),以近期预后为应变量,对36个可能影响近期预后的因素进行单因素分析.计量资料如脑脊液中各项指标的组间比较采用t检验;计数资料,如年龄分组、性别、临床表现、脑积液检测等组间比较采用x2检验.再将差异具有统计学意义的10个变量进行多因素逐步logistic回归分析,P＜0.05为差异有统计学意义.采用SPSS 18.0软件进行统计学分析.结果 单因素分析显示:呕吐[近期预后良好者及不良者分别为50.9％(27/53)、76.7％(23/30),x2=5.292];脑膜刺激征[近期预后良好及不良者分别为67.9％(36/53)、100.0％(30/30),x2=9.318];脑神经损害[近期预后良好及不良者分别为11.3％(6/53)、33.3％(10/30),X2=13.561];瘫痪[近期预后良好及不良者分别为5.7％(3/53)、26.7％(8/30),x2=7.353];临床分期[近期预后良好者早期、中期、晚期分别为26.4％(14/53)、56.6％(30/53)、17.0％(9/53),不良者分别为3.3％(1/30)、30.0％(9/30)、66.7％(20/30),x2=22.162];昏迷[近期预后良好及不良者分别为17.0％(9/53)、60.0％(18/30),x2=14.922];抽搐[近期预后良好及不良者分别为22.6％(12/53)、70.0％(21/30),x2=17.939];颅脑影像学改变[近期预后良好者影像学正常、单纯脑积液、单纯脑实质病灶、脑积液+脑实质病灶分别为49.1％(26/53)、32.1％(17/53)、15.1％(8/53)、3.7％(2/53),不良者分别为16.7％(5/30)、56.7％(17/30)、6.7％(2/30)、20.0％(6/30),x2=14.571];脑脊液蛋白量高[近期预后良好与不良者分别为(1.38±1.07)g/L、(2.29±1.93) g/L,t=2.741];脑脊液氯化物低[近期预后良好与不良者分别为(115.59±8.85) mmol/L、(109.55±7.83) mmol/L,t=3.116]等10项指标与近期预后不好相关(P值均＜0.05).多因素分析显示:出现昏迷(OR=13.670,95％CI=4.268～43.768)、脑积液(OR=6.895,95％CI=1.439～33.031)、临床分期为晚期(OR=10.580,95％CI=2.866～38.091)是影响TBM近期预后的独立危险因素.结论 出现昏迷和脑积液、临床分期属晚期为影响儿童TBM近期预后的危险因素,尽早明确诊断并给予治疗,此为改善近期预后的最重要方面.     

某新建医院连续五年多重耐药菌目标性监测结果分析

目的 了解某新建医院多重耐药菌（MDRO）的分布特征及变化趋势,明确 MDRO 防控工作的重点。方法 收集郑州颐和医院2013年7月—2018年6月住院患者检出的目标性病原菌株,对其中分离的MDRO分布及变化趋势进行统计分析。结果 5年间共检出目标性病原菌7 395株,其中MDRO共812株。分离的MDRO中以耐碳青霉烯类鲍曼不动杆菌（CR-AB）居多（185株,22.78%）,其次为耐碳青霉烯类肺炎克雷伯菌（CR-KP,180株,22.17%）。5年间MDRO总检出率为10.98%,年均检出率呈总体升高的趋势（χ2=20.245,P < 0.001）。MDRO感染类型以社区感染为主（535 例,65.89%）,本院 MDRO 感染患者主要集中在神经外科、重症医学科、神经内科、呼吸科。结论 我院MDRO防控形势正随着开诊时间的延长而逐渐严峻,CR-AB和CR-KP的监测和管理是MDRO防控工作的重点。     

苯乙双胍通过影响线粒体功能促进A549/DDP细胞凋亡

目的 探究苯乙双胍抑制 A549/DDP细胞增殖并促进其凋亡的可能机制。方法 MTS法检测顺铂（顺铂 组）和苯乙双胍（苯乙双胍组）对 A549/DDP 细胞和 A549 细胞的细胞活力（24 h 和 48 h）的影响。苯乙双胍组以 2.5 mmol/L苯乙双胍处理,对照组采用PBS处理,MTS法检测苯乙双胍对A549/DDP细胞增殖的影响,克隆形成实验检测 苯乙双胍对 A549/DDP细胞克隆形成能力的影响,流式细胞术检测苯乙双胍对 A549/DDP细胞凋亡和活性氧（ROS） 胞内线粒体质量（Mitotracker）、钙离子（Rhod-2）的影响,实时荧光定量PCR检测线粒体DNA（mtDNA）变化,三磷酸腺 苷（ATP）试剂盒检测 ATP的变化,Western blot检测苯乙双胍对线粒体氧化磷酸化复合物表达的影响。结果 与顺 铂组比较,苯乙双胍组A549/DDP细胞在24 h和48 h的细胞活力降低（P＜0.05）,而2组间A549细胞24 h和48 h活力 差异无统计学意义。顺铂处理48 h时A549/DDP细胞活力均高于A549细胞（P＜0.05）,而24 h间差异无统计学意义; 苯乙双胍处理的A549/DDP细胞活力低于A549细胞（P＜0.05）。与PBS组相比,苯乙双胍组A549/DDP细胞的24 h和 48 h 增殖率、集落形成数减低,而凋亡率升高,ROS 水平增高,Mitotracker、Rhod-2、mtDNA 及 ATP 水平降低（P＜ 0.05）,线粒体氧化磷酸化复合物Ⅰ中的NDUFB8蛋白、复合物Ⅱ中的SDHB蛋白和复合物Ⅳ中的MTCO1蛋白表达明 显降低（P＜0.05）。结论 （1）A549/DDP细胞较 A549细胞对苯乙双胍更为敏感,但对顺铂耐受性较 A549细胞强。 （2）苯乙双胍通过增加细胞内 ROS、减少线粒体质量、钙离子和 mtDNA、抑制线粒体氧化磷酸化复合物表达,减少 ATP生成,从而抑制A549/DDP细胞增殖并促进其凋亡。     

Antiinfective therapy with a small molecule inhibitor of Staphylococcus aureus sortase

Methicillin-resistant Staphylococcus aureus (MRSA) is the most frequent cause of hospital-acquired infection, which manifests as surgical site infections, bacteremia, and sepsis. Due to drug-resistance, prophylaxis of MRSA infection with antibiotics frequently fails or incites nosocomial diseases such as Clostridium difficile infection. Sortase A is a transpeptidase that anchors surface proteins in the envelope of S. aureus, and sortase mutants are unable to cause bacteremia or sepsis in mice. Here we used virtual screening and optimization of inhibitor structure to identify 3-(4-pyridinyl)-6-(2-sodiumsulfonatephenyl)[1,2,4]triazolo[3,4-b][1,3,4]thiadiazole and related compounds, which block sortase activity in vitro and in vivo. Sortase inhibitors do not affect in vitro staphylococcal growth yet protect mice against lethal S. aureus bacteremia. Thus, sortase inhibitors may be useful as antiinfective therapy to prevent hospital-acquired S. aureus infection in high-risk patients without the side effects of antibiotics.The gram-positive bacterium Staphylococcus aureus colonizes the human skin and nares yet also causes invasive diseases such as skin and soft tissue infections, osteomyelitis, pneumonia, bacteremia, sepsis, and endocarditis (1). Methicillin-resistant S. aureus (MRSA) acquired resistance against many different drugs, including β-lactam, cephalosporin, fluoroquinolone, aminoglycoside, tetracycline, macrolide, trimethoprim-sulfamethoxazole, and vancomycin antibiotics (2). In the United States, MRSA isolates are responsible for >50% of S. aureus infections in hospitals and long-term care facilities (3). Individuals at high risk of MRSA infection include very-low-birth-weight neonates, elderly, and patients with indwelling catheters, endotracheal intubation, medical implantation of foreign bodies (prosthetic joints, implants and heart valves), trauma, surgical procedures, diabetes, dialysis, and immunosuppressive or cancer therapy (4). Antibiotic prophylaxis is designed to mitigate the risk of S. aureus infection, especially in surgical patients; however, this frequently fails due to drug resistance (5). Importantly, antibiotic therapy suppresses human microbiota and promotes Clostridium difficile infection, which is also associated with increased morbidity and mortality (6, 7). Several trials for vaccines and immune therapeutics were designed to prevent MRSA infection in hospital settings; these efforts have thus far failed to meet their study end points (4).Surface proteins of S. aureus are secreted as precursors with C-terminal sorting signals that are cleaved by sortase A (SrtA) between the threonine (T) and the glycine (G) residues of their LPXTG motif (8, 9). The active site cysteine residue of sortase forms an acyl enzyme intermediate that is relieved by the nucleophilic attack of the amino group (pentaglycine crossbridge) in peptidoglycan synthesis precursors (10). Surface proteins attached to peptidoglycan precursors are subsequently incorporated into the cell wall envelope and displayed on the staphylococcal surface (9). Genome sequencing revealed that all S. aureus isolates encode 17–21 surface proteins with LPXTG sorting signals, which fulfill diverse functions during the infectious process (11). SrtA mutants cannot assemble surface proteins into their envelope and are unable to form abscess lesions in organ tissues or cause lethal bacteremia when inoculated into the bloodstream of mice (12, 13). In contrast, mutations that abrogate the expression of secreted virulence factors may cause attenuation but do not abrogate the ability of S. aureus to cause infectious diseases (12).We reasoned that small molecule inhibitors blocking SrtA may be useful as antiinfectives to prevent S. aureus infection without affecting the growth of other bacteria. If so, such compounds could be used to reduce the incidence of MRSA infections without the side effects of antibiotics.     

Fluorescent perylene derivative functionalized titanium oxide gel for sensitive and portable ascorbic acid detection

An inorganic titanium oxide (TiO) gel sensor was demonstrated for convenient detection of ascorbic acid (AA). It is composed of TiO (PI–TiO) functionalized with a perylene diimide derivative containing carboxylic groups as a new soft dopant material. A traditional solvothermal reaction is adopted to prepare the PI–TiO composite, which exhibits a different spectrum according to the reaction time. The final gel possesses a strong chelating affinity with AA molecules, in which phenol hydroxyl groups are shown to compete with those already present in PI. We further utilize the functionalized gel to prepare a series of films with a simple and portable AA response. A visual colour variation can be recognized by the naked eye, together with obvious fluorescence changes for selective and sensitive AA detection. Finally, the as-prepared gel film displays good stability and reproducibility for real sample responses with satisfying results.

A fluorescent inorganic titanium oxide gel sensor was prepared from perylene diimide functionalized composite materials, and applied for sensitive and portable ascorbic acid detection.     

应用正交试验减少静脉用药集中调配中心难溶性抗菌药物残留量

[摘要]目的：利用正交试验降低静脉用药调配中心难溶抗菌药物的残留量。方法：选定溶媒类型、溶媒体积和溶药针类型三个因素,每个因素确定两个水平,即溶媒类型为0.9%氯化钠注射液和灭菌注射用水,溶媒体积为5 mL和8 mL,溶药针类型为直孔溶药针和侧孔溶药针,进行三因素两水平的正交试验,考察各个因素对静脉用药调配中心难溶抗菌药物残留体积和残留量的影响。结果：影响静脉用药调配中心难溶抗菌药物残留体积的主次因素为溶药针类型最大,溶媒体积次之,溶媒类型最小;影响残留量的主次因素为溶媒体积最大,溶药针类型次之,溶媒类型最小。结论：选择适宜溶媒类型、溶媒体积和溶药针类型调配难溶性抗菌药物,可降低西林瓶内的残留量,提高成品输液质量。     

临床药师对1例视神经炎伴病毒感染患儿的药学监护实践

目的：探讨临床药师在视神经炎伴病毒感染患儿治疗中的作用,为儿童视神经炎治疗中的药物选用提供参考。方法：临床药师运用药学专业知识和最新的临床研究证据,参与1例视神经炎伴病毒感染患儿的药学监护实践,协助临床调整治疗方案,并对患儿家属进行用药教育。结果：通过临床药师的药学监护实践,临床医师及时合理地调整用药方案,改变了不合理的用药习惯,保障了患儿用药安全。患儿经过治疗,病情好转出院。结论：临床药师实施药学监护,可优化药物治疗方案,促进激素及抗病毒药物等在儿童病毒感染诱发相关视神经炎治疗中的合理应用。     

Preeclampsia in systemic lupus erythematosus pregnancy: a systematic review and meta-analysis

Clinical Rheumatology - The impact of systemic lupus erythematosus (SLE) on preeclampsia is still obscure. This study was performed to systematically assess the association between preeclampsia and...