Guidelines for the diagnosis,treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli

The dissemination of carbapenem-resistant Gram-negative bacilli (CRGNB) is a global public health issue. CRGNB isolates are usually extensively drug-resistant or pandrug-resistant, resulting in limited antimicrobial treatment options and high mortality. A multidisciplinary guideline development group covering clinical infectious diseases, clinical microbiology, clinical pharmacology, infection control, and guideline methodology experts jointly developed the present clinical practice guidelines based on best available scientific evidence to address the clinical issues regarding laboratory testing, antimicrobial therapy, and prevention of CRGNB infections. This guideline focuses on carbapenem-resistant Enterobacteriales (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Pseudomonas aeruginosa (CRPA). Sixteen clinical questions were proposed from the perspective of current clinical practice and translated into research questions using PICO (population, intervention, comparator, and outcomes) format to collect and synthesize relevant evidence to inform corresponding recommendations. The grading of recommendations, assessment, development and evaluation (GRADE) approach was used to evaluate the quality of evidence, benefit and risk profile of corresponding interventions and formulate recommendations or suggestions. Evidence extracted from systematic reviews and randomized controlled trials (RCTs) was considered preferentially for treatment-related clinical questions. Observational studies, non-controlled studies, and expert opinions were considered as supplementary evidence in the absence of RCTs. The strength of recommendations was classified as strong or conditional (weak). The evidence informing recommendations derives from studies worldwide, while the implementation suggestions combined the Chinese experience. The target audience of this guideline is clinician and related professionals involved in management of infectious diseases.     

胰腺坏死组织感染并发十二指肠瘘诊治及预后研究

目的 研究胰腺坏死组织感染（IPN）病人并发十二指肠瘘的诊治以及预后情况。方法 回顾性分析2018年1月至2019年12月东部战区总医院重症胰腺炎治疗中心510例IPN病人资料,其中并发十二指肠瘘病人46例,按照倾向性评分（卡钳值0.2）进行1∶1匹配,将其与非十二指肠瘘病人进行1∶1匹配分析。结果 IPN并发十二指肠瘘的发生率为9.0%（46/510）。76.1%十二指肠瘘通过窦道造影确诊;十二指肠瘘主要发生在十二指降部或升部,占91.2%;鼻肠管可以解决绝大部分（91.4%）十二指肠瘘病人的营养通路问题。非手术干预治愈率达97.82%。倾向性评分分析结果表明与IPN未并发十二指肠瘘病人相比,并发十二指肠瘘病人的住院时间更长［（40.93±34.02）d vs.（29.35±19.40） d,P=0.048］,腹腔出血发生比例较高［20例（43.5%） vs. 11例（23.9%）,P=0.047］;但在全身并发症急性呼吸窘迫综合征（ARDS）［29例（61.7%）vs. 24例（52.1%）,P=0.291］、AKI［22例（46.8%）vs. 23例（50.0%）,P=0.835］发生率和死亡率［7例（15.2%）vs. 6例（13.0%）,P=0.765］方面差异均无统计学意义。结论 窦道造影是IPN并发十二指肠瘘的主要诊断方式;非手术治疗是十二指肠瘘的主要治愈方式;IPN并发十二指肠瘘病人的住院时间更长,出血发生率更高。     

肠-菌-肝轴及其在肠衰竭相关性肝损害发生发展中的作用

由于长期的肠道摄入不足,肠衰竭患者不得不依赖肠外营养(PN)来维持能量和正常的生理需求。然而PN在提供能量及营养物质的同时,也会引起肝脏损害。此外,由于肠道结构和内环境发生改变,IF患者往往伴随着肠道菌群失调及小肠细菌过度生长,过度生长的细菌代谢产生的毒性介质可诱导肠道炎性反应和胆汁酸代谢紊乱,最终导致肠黏膜屏障功能受损及肠衰竭相关性肝损害(IFALD)。自1998年Marshall首次提出肠-肝轴的概念以来,肠-肝轴紊乱在IFALD发生发展中的作用也备受关注。肠道-肝脏之间的"对话"是维持肝脏代谢和肠道内稳态平衡的关键,二者相互作用,互为因果。然而,作为一个"被遗忘的器官",肠道菌群在IFALD发病过程中的作用并没有得到很好的体现。因此,笔者首次提出肠-菌-肝轴这样一个全新的概念,试图强调肠道菌群是肠-肝轴中的重要一环,三者之间的相互作用在IF患者肠道和肝脏损害过程中扮演着重要的角色。对肠-菌-肝轴这一概念的理解和深入研究,将对理解IFALD的发病机制和改进防治措施具有重要意义。     

Anterior tibial artery injury is not the contraindication of medial plantar flap: digital subtraction angiography evidence and clinical application

The medial plantar artery (MPA) is often sacrificed as the vascular pedicle of the medial plantar flap (MPF). However, for patients with ankle soft tissue defect caused by traffic accident, the anterior tibial artery (ATA) could be damaged and the blood supply of the distal foot would only come from the MPA and the lateral plantar artery (LPA). In this case, sacrificing the MPA for the MPF means that the LPA will become the mainly source of blood supply of the distal foot. Whether the blood supply of the distal foot is adequately guaranteed remains to be discussed. A total of seven patients with ankle soft tissue defect and ATA injury were enrolled in the study. The digital subtraction angiography (DSA) was performed to observe the hemodynamics of the ipsilateral foot. The MPF was harvested only when the foot arterial network consisting of the MPA, the LPA, the deep plantar arch, and the deep plantar artery of DPA, and the blood redistribution existed. DSA results showed the blood from the posterior tibial artery was redistributed to the ipsilateral foot and the MPA is not the dominant artery in the foot. Seven MPFs were harvested, and all flaps survived completely. No complications, such as pain, ulcer, and necrosis, occurred in the ipsilateral toes. The DSA could accurately and intuitively evaluate the hemodynamics of foot in patients with ATA injury. The DSA data and clinical practice proved that the ATA injury is not the contraindication of the MPF.     

基于荧光素酶生物发光检测方法的研究及其应用进展

生物发光现象广泛存在于自然界中,不管是在陆地或是海洋都有发光生物的踪迹。其中基于荧光素酶的生物发光系统被广泛研究,启发着人类在基因、表观遗传等方面进行探索,并且开发出一系列相关的检测方法,用于体内体外各方面研究。本文从生物发光系统、荧光素酶的种类以及荧光素酶生物发光检测方法的开发与应用这几个方面进行总结,简要概括近年来基于荧光素酶生物发光检测的研究进展。     

The clinical and pathological characteristics of Chinese patients with pauci-immune crescent golmerulonephritis

Objective　To investigate the clinical and pathological characteristics of pauci-immune crescent glomerulo～nephritis (PICGN) in Chinese patients. Methods　During 13 years (1985-1998), 6400 patients underwent non-transplanting renal biopsy. Twenty-four patients were diagnosed as PICGN. All clinical and laboratory data of these patients were collected from the patients’ records and used for detailed analysis. The diagnosis is based on clinico-pathologic findings. Results　Of the 24 patients, 16 were females and 8 were males, with median age of 33 years (ranged 10-76 years). Microscopic polyarteritis (MPA) (33.3%) and systemic vasculitis (8.3%) were the secondary diseases. The incidence of PICGN was 0.38% in renal biopsies and 22.9% in crescentic glomerulonephritis. Clinically, most patients (75.0%) showed rapidly progressive nephritis with enlarged kidneys. At onset, gross hematuria was noted in 58.3% of patients, hypertension in 45.8%, nephrotic syndrome in 41.7%, and oliguria in 25.0%. However, systemic symptoms were rare except for anemia. Pathologically, necrosis of glomerular capillaries (62.5%), infiltration of monocytes and neutrophil cells in glomeruli (66.7%), and vasculitis in the interstitium (53.3%) were observed. In addition, glomerulosclerosis was noted in 45.8%, severe tubular atrophy in 83.3% and interstitial fibrosis in 75.0%. Anti-neutrophil cytoplasmic antibodies (ANCAs) were positive in 52.2%. All patients except two received intensively immunosuppressive therapy. Sixteen patients were available for long-term follow up (median 29.8 months, range 8-92 months). Twelve of them had life-sustaining renal function, four had normal serum creatinine (<124?μmol/L) and only 4 patients were dialysis-dependent. Conclusion　PICGN is not rare in China. Early diagnosis and administration of immunosuppressive therapy, particularly in patients with rapidly progressive glomerulonephritis (RPGN), are important for good prognosis.     

短肠综合征的康复治疗

目的总结27例短肠综合征病人康复治疗的经验,介绍短肠康复治疗的具体方法,探讨改善短肠病人营养状况、促进肠功能代偿的措施。方法短肠康复治疗包括营养支持、应用谷氨酰胺和生长激素促进肠粘膜生长、富含膳食纤维的短肠康复饮食、减轻短肠临床症状以及预防和治疗短肠并发症等措施。1997年1月至2000年7月间共27例短肠患者接受了29次康复治疗,患者平均年龄38.5岁±19.3岁。剩余小肠长度范围15～80cm,平均46.8cm±23.4cm,15例有回盲瓣。从肠切除至接受康复治疗的平均时间为86d±105d。结果治疗后病人的营养状况明显改善,肠道吸收功能有所增强。随访超过2年者8例,4例完全脱离肠外营养,随访时间超过1年者13例,有10例完全脱离肠外营养。结论短肠康复治疗能够有效地改善短肠病人的营养状况、并能促进肠功能代偿,治疗效果与残留小肠长度、治疗开始的时间和病人年龄有关,及早进行康复治疗能够促进肠功能代偿,减少病人对肠外营养的依赖。     

IDENTIFICATION OF GLUCOSE TRANSPORTER-1 AND ITS FUNCTIONAL ASSAY IN MOUSE GLOMERULAR MESANGIAL CELLS CULTURED IN VITRO

INTRODUCTION Glomerular mesangial cells play a key role in the development of diabetic glomerular lesions. There is a close correlation between expansion of the mesangium of the glomerulus and the clinical manifestations of diabetic nephropathy(1). Although it has become evident that the accumulation of extracellular matrix (ECM) occurs in the diabetic glomerulus and that mesangial cells in culture demonstrate enhanced production of ECM in response to elevated glucose levels (2), the me…     

IgA肾病患者的扁桃体免疫组织化学观察

目的：了解ＩｇＡ肾病（ＩｇＡ－Ｎ）与扁桃体免疫异常的关系。方法：经肾穿刺活检确诊为ＩｇＡ－Ｎ３１例,以慢性扁桃体炎１６例作对照,扁桃体切除术后运用ＡＢＣ方法对扁桃体组织进行免疫组化标记。结果：两组扁桃体在ＩｇＡ、ＩｇＧ的表达上存在明显的区别,ＩｇＡ－Ｎ患者的扁桃体组织内产生ＩｇＡ的淋巴细胞数显著增加,结论：ＩｇＡ－Ｎ患者存在着扁桃体免疫异常,切除扁桃可预防抗原入浸,消除扁桃体来源的ＩｇＡ,减少循环中的ＩｇＡ免疫复合物形成,进一步使肾小球基底膜区的ＩｇＡ免疫复合物沉积减少。