Clinical importance of "breakthrough" bacteremia

Fifty-one episodes of bacteremia and a single episode of fungemia occurred during treatment with seemingly adequate doses of appropriate antibiotics. Clinical findings in these "breakthrough" bacteremias and fungemia were compared with those in 448 non-breakthrough episodes. Breakthrough was more likely to be caused by facultative or aerobic gram-negative rods (e.g., Enterobacteriaceae and Pseudomonas species) than by anaerobes. Of the underlying conditions examined, immunosuppressive doses of glucocorticosteroids, diabetes mellitus, and moderate renal failure were significantly more frequent in patients with breakthrough. A significant association was also observed between an intra-abdominal primary focus of infection (abscesses, biliary tract or bowel infections) and the occurrence of breakthrough. Mortality in breakthrough bacteremia was 61 percent compared with 40 percent in non-breakthrough episodes. The phenomenon of breakthrough bacteremia shows the potential limitations of antibiotic therapy alone.     

Metabolic Patterns (NAD(P)H) in Rat Basophilic Leukemia (RBL-2H3) Cells and Human Hepatocellular Carcinoma (Hep G2) Cells with Autofluorescence Imaging

Although the spatial and temporal distributions of cellular NAD(P)H concentrations have been theoretically predicted as typical patterns of the metabolism in living cells, so far such a pattern was observed only in neutrophils. In this work, the dynamic NAD(P)H distributions in rat basophilic leukemia (RBL-2H3) and human hepatocellular carcinoma (Hep G2) cells were studied by imaging the autofluorescence of cellular NAD(P)H with a sensitive CCD detector in a confocal microscope. The typical pattern of the cytoplasmic NAD(P)H wave traveling along the long axis of the elongated cell with a velocity of 2.2±0.6?μm/s was detected in RBL-2H3 cells. While in the case of Hep G2 cells, only the oscillation of the mitochondrial NAD(P)H was observed because the NAD(P)H mainly localized in mitochondria of Hep G2 cells. These results confirm the metabolic pattern of NAD(P)H in living cells and suggest that the expression of the metabolic pattern probably differs in different cell lines.     

东莞市塘厦镇社区医疗的慢性咳嗽诊治现状分析

目的了解东莞市塘厦镇社区医疗的慢性咳嗽诊治现状。方法采用问卷调查方式,于2013年1月共调查东莞市塘厦镇1个社区卫生服务中心和17个卫生服务站,共18个服务点。社区卫生服务中心抽取3名全科医生,其余每家卫生服务站抽取2名以上全科医生,共37名医生接受调查。结果仅有11.1%(2/18)的服务点开展X线检查,没有服务点能开展肺功能检查。100%的医生选择抗生素和中(成)药作为首选药物。无医生表示了解并且执行了慢性咳嗽指南,少数医生听说过但不了解(8.1%)。94.6%(35/37)的医生对慢性咳嗽的诊治现状不满意,其中81.1%(30/37)的医生认为其主要原因是患者经济因素。结论在社区医疗加大推广慢性咳嗽指南,尤其是经验性治疗已迫在眉睫。     

普通患者疾病感知现状及影响因素研究

背景　国内外研究均表明,患者的疾病感知极大影响着其治疗及预后效果。因此,探讨我国普通患者的疾病感知现状及影响因素十分重要,可以为改善我国患者负性疾病感知和提升患者健康提供依据。目的　探讨普通患者疾病感知现状及影响因素。方法　于2018年1-3月,通过方便取样的方式抽取广东省8家医院的500例患者进行现场调查,调查工具选用疾病感知问卷简化版（BIPQ）、维克森林医师信任量表（WFPTS）、中国版10项目大五人格量表（TIPI-C）、病人健康问卷2条目（PHQ-2）,最终获得有效数据384例（76.8%）。结果　普通患者的BIPQ总得分为（38.6±9.1）分,认知表征、情绪表征、疾病理解能力维度得分分别为（22.1±7.0）、（13.3±4.0）、（3.2±2.2）分。不同职业、医疗费用对家庭经济影响程度患者的BIPQ总得分存在统计学差异（P<0.05）。Pearson相关分析结果显示：患者BIPQ总得分与WFPTS总得分及仁爱、技术能力维度得分,以及TIPI-C宜人性、情绪稳定性维度得分呈线性负相关（r值为-0.39~-0.14,P<0.05）;患者BIPQ总得分与PHQ-2得分呈线性正相关（r=0.41,P<0.05）。多元线性逐步回归分析结果显示,WFPTS仁爱维度得分、TIPI-C情绪稳定性维度得分、PHQ-2得分是患者BIPQ总得分的影响因素（b值分别为-0.337、-0.781、2.308,P<0.05）。结论　我国普通患者对自身所患疾病认识不足,表现出较多消极情绪,对治疗缺乏信心;患者的抑郁情绪和医疗费用造成的经济压力是疾病感知的危险因素,情绪稳定性和医生的人文关怀是疾病感知的保护因素。     

Electric current induced in teeth by electromagnetic fields from electric toothbrushes and curing lights

PurposeThe purpose of this study was to examine the electric current induced in teeth and tooth-bonded brackets by electromagnetic fields from electric toothbrushes and the curing lights used for photo-activating light-cured resins.Materials and methodsCuring lights-generated low-frequency magnetic fields (1–2000 Hz) were measured with a spectrum analyzer. Temperature changes induced in the enamel and pulpal dentin surface of extracted upper premolar teeth (with or without a stainless steel or zirconia bracket) by electric toothbrushes and curing lights were estimated using an infrared thermometer. Electric current induced in these extracted teeth by electric appliances was estimated using a digital multimeter.ResultsCuring lights generated low-frequency magnetic fields. Irradiation of the tooth surface by curing lights elevated the temperature of the enamel and pulpal dentin surfaces, but there were no differences between curing lights. About electric current induced in extracted teeth (with or without a bracket) by electric toothbrushes and curing lights, the highest current was induced in teeth to which a zirconia bracket was bonded, whereas the lowest current was in unmodified teeth. Intermediate currents were generated in teeth bonded to stainless steel brackets.ConclusionThe low-frequency magnetic fields induced by electric toothbrushes and light curing units induce electric current in tooth tissue, irrespective of whether these teeth are bonded to stainless steel or zirconia brackets.     

Intrahippocampal infusion of the Ih blocker ZD7288 slows evoked theta rhythm and produces anxiolytic‐like effects in the elevated plus maze

Hippocampal theta rhythm has been associated with a number of behavioral processes, including learning and memory, spatial behavior, sensorimotor integration and affective responses. Suppression of hippocampal theta frequency has been shown to be a reliable neurophysiological signature of anxiolytic drug action in tests using known anxiolytic drugs (i.e., correlational evidence), but only one study to date (Yeung et al. ( 2012 ) Neuropharmacology 62:155–160) has shown that a drug with no known effect on either hippocampal theta or anxiety can in fact separately suppress hippocampal theta and anxiety in behavioral tests (i.e., prima facie evidence). Here, we attempt a further critical test of the hippocampal theta model by performing intrahippocampal administrations of the I_h blocker ZD7288, which is known to disrupt theta frequency subthreshold oscillations and resonance at the membrane level but is not known to have anxiolytic action. Intrahippocampal microinfusions of ZD7288 at high (15 µg), but not low (1 µg) doses slowed brainstem‐evoked hippocampal theta responses in the urethane anesthetized rat, and more importantly, promoted anxiolytic action in freely behaving rats in the elevated plus maze. Taken together with our previous demonstration, these data provide converging, prima facie evidence of the validity of the theta suppression model. © 2012 Wiley Periodicals, Inc.     

Estimation of Filling and Afterload Conditions by Pump Intrinsic Parameters in a Pulsatile Total Artificial Heart

A physiological control algorithm is being developed to ensure an optimal physiological interaction between the ReinHeart total artificial heart (TAH) and the circulatory system. A key factor for that is the long‐term, accurate determination of the hemodynamic state of the cardiovascular system. This study presents a method to determine estimation models for predicting hemodynamic parameters (pump chamber filling and afterload) from both left and right cardiovascular circulations. The estimation models are based on linear regression models that correlate filling and afterload values with pump intrinsic parameters derived from measured values of motor current and piston position. Predictions for filling lie in average within 5% from actual values, predictions for systemic afterload (AoP_mean, AoP_sys) and mean pulmonary afterload (PAP_mean) lie in average within 9% from actual values. Predictions for systolic pulmonary afterload (PAP_sys) present an average deviation of 14%. The estimation models show satisfactory prediction and confidence intervals and are thus suitable to estimate hemodynamic parameters. This method and derived estimation models are a valuable alternative to implanted sensors and are an essential step for the development of a physiological control algorithm for a fully implantable TAH.     

一氧化氮吸入联合高频震荡通气治疗新生儿严重呼吸衰竭的疗效分析

目的 探讨一氧化氮吸入(iNO)联合高频震荡通气(HFOV)治疗新生儿严重呼吸衰竭疗效。 方法 选取2013年3月至2016年3月60例HFOV中高参数设置下氧合差的患儿[吸入氧浓度(FIO₂)＞60%,经皮血氧饱和度(TcSO₂)＜80%],采用随机数字表法分为观察组及对照组,观察组予iNO联合HFOV治疗,对照组予单纯HFOV治疗,治疗中监测血气分析、血氧饱和度、血压、心率,监测血常规、出凝血时间、高铁血红蛋白等指标。比较两组的机械通气时间、救治成功率以及并发症发生率。 结果 iNO联合HFOV,能显著改善患儿氧合指数,使呼吸机参数逐渐下调至安全范围,且合理调整参数后患儿无明显不适,缩短患儿机械通气时间,提高呼吸衰竭患儿的抢救成功率。机械通气时间对照组为(107.00±39.60)h,观察组为(89.34±22.75)h,两组比较,差异有统计学意义(P＜0.05);死亡率对照组32.14%,观察组9.37%,两组比较,差异有统计学意义(P＜0.05)。观察组在未用iNO之前PH值、氧分压(PaO₂)、二氧化碳分压(PaCO₂)、动脉氧分压与吸入氧浓度比(PaO₂/FiO₂)、氧合指数(OI)值均差异无统计学意义(P＞0.05)。iNO后2 h、24 h比较差异有统计学意义(P＜0.05)。     

Feasibility and usability of measuring receipt of sealants in 2 states

BackgroundThe authors examined the reliability and validity of the Dental Quality Alliance childhood sealant measure under actual use conditions in Texas and Florida. The 2 states provide care for almost 20% of children in Medicaid nationally.MethodsThe authors used dental claims data to examine the reliability of the caries risk assessment component of the measure. They examined validity using a 3-year look-back period to identify children who were inaccurately included in the measure denominator as sealant eligible when they were not owing to already sealed, missing, or restored teeth.ResultsThe children identified at elevated risk varied between the states, with 85% at elevated risk in Texas and 39% in Florida in 2017. Different methods can be used to calculate risk, raising questions about reliability. In Texas, 31% of children included in the denominator were not eligible to receive sealants owing to already sealed, missing, or restored teeth. The magnitude of the underestimation increased with age, so by the time children were 9 years old, 40% were not measure eligible yet included in the denominator. Similar results were observed for Florida.ConclusionsThe authors propose eliminating the caries risk assessment requirement and incorporating a 3-year look-back period to identify already sealed, missing, or restored molars.Practical ImplicationsThe reliability and validity of the sealant measure needs to be enhanced. Measure misspecification in which children are not correctly identified as needing sealants can contribute to inaccurate development of quality improvement goals, performance improvement projects, or pay-for-quality programs.