Enterobacteriaceae bacteremia: Risk factors for ESBLPE

Objectives

The increasing prevalence of extended spectrum beta-lactamase producing enterobacteriaceae (ESBLPE) requires defining the use of carbapenems in first intention. We analyzed the associations between enterobacteriaceae bacteremia (EbBact) and ESBLPE carriage during 10 years in a 950-bed teaching hospital.

Methods

We analyzed a 10-year (July 2001 to June 2011) prospective collection of bacteremia cases including 2 databases: (1) EbBact and (2) a computerized database of patients carrying EBLSE. Only one episode of EbBact was analyzed per patient and hospital stay. Factors associated with ESBLPE bacteremia were assessed by univariate and multivariate logistic regression analysis.

Results

Overall, 2355 cases of EbBact were identified, among which 135 (5.7%) were ESBLPE (2001–05: 1.4%, 2006–09: 7.6%, 2010–11: 14.2%). ESBLPE bacteremia was observed in 52 of the 88 (59%) patients carrying ESBLPE and in 83/2267 (3.7%) patients not known to be colonized with ESBLPE. Factors associated with ESBLPE bacteremia in patients not known to be colonized were: female gender (ORa = 0.56, CI95% [0.34–0.91]), hospitalization in the ICU (ORa = 2.51 [1.27–5.05]) or medical/surgical wards (ORa = 1.83 [1.04–3.38]), the period (2006–09, ORa = 4.08 [2.21–8.16]; 2010–11, ORa = 8.17 [4.14–17.06] compared to 2001–05), and history of EbBact (ORa = 2.29 [0.97–4.79]).

Conclusion

In case of EbBact, patients known to be colonized with ESBLPE present with ESBLPE bacteremia in more than half of the cases, requiring carbapenems as empirical antibiotic treatment. The global prevalence of ESBLPE among patients presenting with EbBact not known to be colonized with ESBLPE was 3.7%.     

优质延续护理在出院脑卒中患者中的应用效果

目的探讨优质延续护理在出院脑卒中患者中的应用效果。方法选取2012年11月-2013年8月的32例脑卒中患者作为对照组,2013年9月-2014年2月的35例脑卒中患者作为观察组。对照组按常规进行出院指导,观察组在对照组的基础上进行优质延续护理。比较两组的MBI评分、患者依存性和满意度。结果观察组出院1个月的MBI评分显著高于对照组,差异有统计学意义（P〈0.05）。观察组出院3、6个月的MBI评分显著高于对照组,差异有统计学意义（P〈0.01）。观察组的依存性显著高于对照组,差异有统计学意义（P〈0.01）。观察组的患者满意度显著高于对照组,差异有统计学意义（P〈0.01）。结论优质延续护理模式能够提高患者的日常生活能力、依从性及服务的满意度。     

对双亲/孩子结构连接算法的研究与改进

结合区间编码和结点模型映射方法提出一种用于关系数据库的扩展存储模式.通过按广度优先遍历XML树实现对双亲/孩子关系结构连接算法的改进.改进后的算法降低了内存空间的开销,缩小了列表的扫描范围,明显提高了查找匹配速度,达到了查询优化的目的.     

产生ESBLs和AmpC酶的肠杆菌科细菌检测及耐药性分析

目的了解我院产ESBLs和AmpC酶细菌的耐药性。方法对产ESBLs菌和产生AmpC酶菌进行表型的筛选和确证,测定21种药物的耐药性。结果 268株菌中检出ESBLs菌136株,检出率50.75%,AmpC酶菌116株,检出率43.28%。单产AmpC酶菌,单产ESBLs菌及产AmpC和ESBLs的菌对青霉素、第二、三代头孢菌素类药物的耐药率明显高于非产酶菌的耐药率,两者相比有显著性差异(P<0.05),多重耐药及泛耐药常见。结论 ESBLs与Amp酶已成为我院肠杆菌科细菌耐药的主要原因。碳青霉烯类、第四代头孢菌素、哌拉西林/三唑巴坦成为我院治疗院内感染的首选药。     

Route-to-route extrapolation of 1,2-dichloroethane studies from the oral route to inhalation using physiologically based pharmacokinetic models

To help develop a comprehensive, quantitative understanding of the hazards of 1,2-dichloroethane (ethylene dichloride, EDC, CAS No. 107-06-2) exposure by the inhalation route, the results of existing subchronic studies and an extended one-generation reproductive toxicity (EOGRT) study recently conducted by the oral route in rats were extrapolated using a physiologically based pharmacokinetic (PBPK) model. The no observed adverse effects levels (NOAELs) for the endpoints of neurotoxicity and reproductive/developmental toxicity were the highest tested doses of 169 and 155 mg/kg-day, respectively. These NOAELs were equivalent to continuous exposure of rats to minimums of 76 ppm and 62 ppm EDC, respectively, using total metabolism of EDC as the dose metric that is equivalent in the oral and inhalation scenarios. In contrast, the subchronic study NOAEL of 37.5 mg/kg-day corresponded to continuous inhalation of 4.4 ppm EDC, based on equivalent extrahepatic metabolism. The selection of the internal metric which serves to establish route-to-route equivalency was found to profoundly influence the NOAEL-equivalent inhalation exposure concentration and thus will be a key determinant of inhalation toxicity reference criteria developed on the basis of EDC studies conducted by the oral route.     

An in vitro study of the design and development of a novel doughnut-shaped minitablet for intraocular implantation

A novel doughnut-shaped minitablet (DSMT) was developed and evaluated as a biodegradable intraocular drug delivery system for rate-modulated delivery of antiviral bioactives. The DSMT device was manufactured using a special set of punches fitted with a central-rod in a Manesty tableting press. The DSMT device released the antiretrovirals foscarnet and ganciclovir at a first-order rate. The erosion kinetics was assessed by gravimetric analysis and scanning electron microscopy. The device gradually eroded when immersed in simulated vitreous humor (SVH) (pH 7.4, 37 °C) and released bioactives in a sustained manner. The novel geometric design and veracity of the DSMT device was retained even after 24 weeks of erosion. When considering the duration of the bioactive released from the DSMT device, it was found that by the careful selection of the type and concentration of polymer employed in formulating the DSMT device, it was possible to produce a device that could release drug for any period up to 12 months.     

Ⅰ、Ⅱa期乳腺癌保留乳房治疗的临床探讨

目的 探讨早期乳腺癌保留乳房治疗的临床应用价值。方法 对37例临床Ⅰ、Ⅱa期乳腺癌行保留乳房的手术治疗 放疗,病例进行回顾性分析。结果 ①手术适应于肿瘤≤3cm的单发病灶,不累及乳晕,乳房大小适中,腋淋巴结不超过N1。②手术范围包括肿瘤扩大切除和全腋淋巴结清扫。③术后必须行全乳房 选择性区域淋巴组织放疗。④随访16—70个月无局部复发、远处转移和死亡。结论 Ⅰ、Ⅱa期乳腺癌行保留乳房手术能明显改善生活质量,疗效和典型根治术相似。     

中国湖北地区23个汉族家系88条染色体MHC扩展单倍型的检测

人MHC-Ⅰ、Ⅱ、Ⅲ类抗原的诸基因座位是紧密连锁的,一起构成MHC-扩展单倍型。我们对我国湖北地区23个家系,共88条染色体的这种单倍型进行了检测,发现仅有HLA-[A11-Cw3-B27-CS31-DR11]两条完全相同,有10条部分相同。此外对HLA-A、C、B、DR与补体型相关情况进行了分析。     

Effects of "Below-Zero" Habituation on Spontaneous Recovery and Dishabituation of the Orienting Response

Twenty male undergraduate Ss underwent habituation of the skin conductance component of the orienting response to a neutral tone, spontaneous recovery, rehabituation, and dishabituation (habituation, H condition). Another 20 Ss underwent the same procedure, except they received an additional 10 stimulus presentations immediately after initial habituation (extended habituation, EH condition). The EH condition resulted in more (not significant) spontaneous recovery and trials to rehabituation than did the H condition, indicating that such a “below-zero” habituation procedure did not strengthen habituation. There were significant differences between the groups in response to a post-rehabituation buzzer (dishabituating stimulus), and in response to the subsequent re-presentation of the original tone stimulus (dishabituation), the EH group giving larger responses than the H group. These latter results were seen as consonant with both the Sokolov (1963) and Groves and Thompson (1970) approaches to habituation, and were discussed in that context.