长春地区儿科院内感染肺炎克雷伯菌耐药性分析及产超广谱β-内酰胺酶检测

目的:探讨儿科院内感染肺炎克雷伯菌超广谱β-内酰胺酶(ESBLs)的耐药特征,为产ESBLs细菌的治疗提供参考。方法:采用纸片琼脂扩散法和双纸片协同试验对肺炎克雷伯菌耐药性及产ESBLs菌株进行监测。结果:从306份标本中分离出85株肺炎克雷伯菌,产ESBLs菌株阳性率为31.8%(27/85);ESBLs阳性株对多种抗生素的耐药率高于ESBLs阴性株,只对亚胺培南敏感。结论:长春地区儿科院内感染肺炎克雷伯菌ESBLs的检出率高并呈多重耐药性。     

扩大外侧入路治疗跟骨关节内骨折的临床观察

目的 探讨扩大外侧入路治疗跟骨关节内骨折的临床效果.方法 2009年6月～2011年6月本院采用扩大外侧入路治疗移位的跟骨关节内骨折70例87足,对患者进行相关影像检查并对术后效果进行评价.结果 手术前后两组患者B（o）hler角和Gissane角差异有统计学意义（P＜0.05）,70例患者单侧骨折49足复位情况较好.70例患者经过治疗,跟骨关节内骨折评分达到65～98分,平均87.9分,优良率为82.8％.结论 扩大外侧入路治疗移位的跟骨关节内骨折,临床效果满意.     

Influence of Carbopol 71G-NF on the release of dextromethorphan hydrobromide from extended-release matrix tablets

The objective of this study was to evaluate the potential of Carbopol^® 71G-NF on the release of dextromethorphan hydrobromide (DM) from matrix tablets in comparison with hydroxypropyl methylcellulose (HPMC^® K15M) and Eudragit^® L100-55 polymers. Controlled release DM matrix tablets were prepared using Carbopol 71G-NF, HPMC K15M, and Eudragit L100-55 at different drug to polymer ratios by direct compression technique. The mechanical properties of the tablets as tested by crushing strength and friability tests were improved as the concentration of Carbopol, HPMC, and Eudragit increased. However, Carbopol-based tablets showed a significantly (P?<?0.05) higher crushing strength and a lower friability than HPMC and Eudragit tablets. No significant differences in weight uniformity and thickness values were observed between the different formulations. It was also found that Carbopol significantly (P?<?0.05) delayed the release of DM in comparison with HPMC K15M and Eudragit L100-55. A combination of HPMC K15M and Eudragit L100-55 in a 1:1 ratio at 20 and 30% significantly (P?<?0.05) delayed the release of DM than Eudragit L100-55 alone. Moreover, blends of Carbopol and HPMC at a 1:1 ratio at the 10, 20, and 30% total polymer concentration were investigated. The blend of Carbopol and HPMC at 10% level significantly (P?<?0.05) slowed the release of DM than Carbopol or HPMC alone, whereas blends at 20 and 30% level significantly (P?<?0.05) delayed the release of DM compared with HPMC or Carbopol alone. The results with these polymer blends showed that it was possible to reduce the total amount of polymers when used as a combination in formulation.     

Stochastic Differential Equations in NONMEM®: Implementation,Application, and Comparison with Ordinary Differential Equations

Purpose The objective of the present analysis was to explore the use of stochastic differential equations (SDEs) in population pharmacokinetic/pharmacodynamic (PK/PD) modeling.Methods The intra-individual variability in nonlinear mixed-effects models based on SDEs is decomposed into two types of noise: a measurement and a system noise term. The measurement noise represents uncorrelated error due to, for example, assay error while the system noise accounts for structural misspecifications, approximations of the dynamical model, and true random physiological fluctuations. Since the system noise accounts for model misspecifications, the SDEs provide a diagnostic tool for model appropriateness. The focus of the article is on the implementation of the Extended Kalman Filter (EKF) in NONMEM^® for parameter estimation in SDE models.Results Various applications of SDEs in population PK/PD modeling are illustrated through a systematic model development example using clinical PK data of the gonadotropin releasing hormone (GnRH) antagonist degarelix. The dynamic noise estimates were used to track variations in model parameters and systematically build an absorption model for subcutaneously administered degarelix.Conclusions The EKF-based algorithm was successfully implemented in NONMEM for parameter estimation in population PK/PD models described by systems of SDEs. The example indicated that it was possible to pinpoint structural model deficiencies, and that valuable information may be obtained by tracking unexplained variations in parameters.     

延续性护理对2型糖尿病患者血糖和生活质量的影响

探讨延续性护理对2型糖尿病患者血糖和生活质量的影响。方法：将60例2型糖尿病患者随机分为实验干预组和对照组,各30例。实验干预组实施延续性护理服务,对照组实施糖尿病常规护理。比较两组患者干预前和干预后3个月血糖控制情况和生活质量的变化。结果：实施干预后3个月,两组血糖水平、生活质量比较差异均有统计学意义（P〈0.05）。结论：在2型糖尿病患者中实施延续性护理干预可以更好地控制患者血糖,并且明显改善其生活质量。     

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%.     

延伸护理及居家护理对糖尿病患者血糖及生活质量、护理满意度的影响

目的探讨延伸护理及居家护理应用于糖尿病患者的效果。方法66例社区糖尿病患者随机分为两组各33例,观察组接受延伸护理及居家护理,对照组接受常规住院护理和社区护理,比较两组的血糖、生活质量和护理满意度。结果观察组的空腹血糖和餐后2 h血糖均显著低于对照组,生活质量各项指标评分以及总评分均显著高于对照组,护理满意度显著高于对照组(P<0.05)。结论延伸护理及居家护理能够显著改善糖尿病患者的血糖水平、生活质量,提高护理满意度。     

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.