Haematogenous Osteomyelitis of the Patella: Report of Three Cases

Three cases of osteomyelitis of the patella are reported. One presented as an acute septic arthritis and another developed a sterile arthritis despite antibiotics. The clinical signs, diagnosis and treatment are discussed. Treatment with rest and antibiotics failed to cure the disease. in all three cases a sequestrectomy was carried out resulting in healing of the affected patella and recovery of knee mobility.     

我院抗菌药物应用现状及措施分析

目的探究我院抗菌药物应用现状及措施.方法 将我院2012年4~9月抗菌药物临床应用情况作为研究对象,进行专题调查.结果 我院抗菌药物品种共计61个,住院病患使用抗菌药物的概率平均为75.26%,使用的强度则平均为108.4,Ⅰ类切口手术与介入治疗抗菌药物预防使用率达到了100.00%,门诊抗菌药物处方比例平均为16.27%.结论 在临床使用抗菌药物方面,相关医生尚不规范,因此必须加强医务人员在该方面的培训,以此保障抗菌药物使用的有效与安全,实现经济合理,减少耐药.     

Infectious diarrhea

Diarrhea caused by enteric infections is a major factor in morbidity and mortality worldwide. An estimated 2-4 billion episodes of infectious diarrhea occur each year and are especially prevalent in infants. This review highlights the cellular and molecular mechanisms underlying diarrhea associated with the three classes of infectious agents, i.e. bacteria, viruses and parasites. Several bacterial pathogens have been chosen as model organisms, including Vibrio cholerae as a classical example of secretory diarrhea, Clostridium difficile and Shigella species as agents of inflammatory diarrhea and selected strains of pathogenic Escherichia coli (E. coli) to discuss the recent advances in alteration of epithelial ion absorption. Many of the recent studies addressing epithelial ion transport and barrier function have been carried out using viruses and parasites. Here, we focus on the rapidly developing field of viral diarrhea including rotavirus, norovirus and astrovirus infections. Finally we discuss Giardia lamblia and Entamoeba histolytica as examples of parasitic diarrhea. Parasites have a greater complexity than the other pathogens and are capable of creating molecules similar to those produced by the host, such as serotonin and PGE2. The underlying mechanisms of infectious diarrhea discussed include alterations in ion transport and tight junctions as well as the virulence factors, which alter these processes either through direct effects or indirectly through inflammation and neurotransmitters.     

Current recommendations for Helicobacter pylori therapies in a world of evolving resistance

Occurrence of resistance, especially to clarithromycin, renders the standard triple therapy used to cure Helicobacter pylori infection ineffective. This review presents the bacteriological and pharmacological basis for H. pylori therapy and the current recommendations. The third-line treatment must be based on clarithromycin susceptibility testing. If the bacteria are still susceptible, failure may come from problems of compliance, hyperacidity or high bacterial load which can be overcome. If the bacteria are resistant, different regimens must be considered, including bismuth and non-bismuth-based quadruple therapies (sequential or concomitant), as well as triple therapies where amoxicillin is administered several times a day to obtain an optimal concentration at the gastric mucosal level. The treatments are becoming more and more complex and ecologically unsatisfactory, waiting for new agents or vaccines.     

Effects of Synthetic Retinoids on the Growth of Bacteria and Their Susceptibility to Antibiotics

Summary

In patients treated with oral retinoids the recovery of Propionibacterium acnes and other anaerobic bacteria in the skin is markedly reduced, whereas an increased colonization of the skin and a significant rise in the incidence of cutaneous staphylococcal infections are observed. Since very little is known about the effects of retinoids on bacteria, in the present study we investigated the influence of 4 retinoids (isotretinoin, etretinate, arotinoid ethyl ester, arotinoid sultane) in 15 different concentrations on the growth of 10 Gram-positive and Gram-negative bacteria in vitro and on their susceptibility to 10 antibiotics.

It was found that all retinoids were not capable of affecting either the growth of bacteria or their susceptibility to antibiotics. It seems reasonable, therefore, to assume that the retinoid-induced changes in cutaneous bacterial flora in vivo are due to mechanisms other than to the direct action of these compounds on bacteria.     

Desmethyl Macrolide Analogues to Address Antibiotic Resistance: Total Synthesis and Biological Evaluation of 4,8,10-Tridesmethyl Telithromycin

There is an urgent need to discover new drugs to address the pressing problem of antibiotic-resistance. Macrolide antibiotics such as erythromycin (1) are safe, broad-spectrum antibiotics used in the clinic since 1954. Herein we report the synthesis and evaluation of 4,8,10-tridesmethyl telithromycin (3), a novel desmethyl analogue of the 3rd-generation drug telithromycin (2), which is a semisynthetic derivative of 1. Analogue 3 was found to possess antibiotic activity and was superior to telithromycin (2) when tested against resistant strains of S. aureus possessing an A→T mutation at position 2058 (E. coli numbering).     

Management of diverticulitis: results of a survey among gastroenterologists and surgeons

Aim The study aimed to investigate current management strategies for left‐sided diverticulitis and compare them with current international guidelines. Differences between surgeons and gastroenterologists and between gastrointestinal and nongastrointestinal surgeons were assessed. Method A web‐based survey of treatment options for uncomplicated and complicated diverticulitis was carried out among surgeons and gastroenterologists in the Netherlands. Only surgeons were asked about surgical strategy. Results A total of 292 surgeons and 87 gastroenterologists responded, representing 92% of all surgical and 46% of all gastroenterology departments. Ninety per cent of respondents treated mild diverticulitis without antibiotics. About one‐fifth (18% gastroenterologists; 19% surgeons) regarded a CT scan as mandatory in the initial assessment. Most surgeons and gastroenterologists used some form of bowel rest, would consider outpatient treatment and would perform a colonoscopy on follow up. For Hinchey Stage 3, 78% of surgeons would consider resection and primary anastomosis and laparoscopic lavage was viewed as a valid alternative by 30% of gastrointestinal and 2% of nongastrointestinal surgeons. For Hinchey stage 4, 46% of gastrointestinal and 72% of nongastrointestinal surgeons would always perform Hartmann’s procedure. Conclusion The treatment of diverticulitis in the Netherlands shows major differences when compared with guidelines for all stages of disease.     

4株志贺菌无抗生素压力下连续传代90次的耐药表型及CRISPR/Cas系统变化

目的 分析无抗生素压力下连续传代90次的4株志贺菌耐药表型及成簇规律间隔短回文重复序列（CRISPR）/CRISPR相关蛋白（Cas）基因变化。方法 对临床分离的4株耐药谱不同的志贺菌进行无抗生素压力连续传代90次,传代结束后用琼脂稀释法检测传代前、后志贺菌最小抑菌浓度;用PCR对CRISPR位点进行扩增并测序,CRISPR Finder和Clustal X 2.1分析CRISPR位点的变化。结果 经无抗生素压力传代90次后,4株志贺菌对某些抗生素的敏感性有不同程度的增加：mel-sf1998024/zz对氨苄西林、头孢氨苄、头孢噻肟、氯霉素的耐药性降低,mel-s2014026/sx对诺氟沙星、甲氧苄啶的耐药性降低,mel-sf2004004/sx对氨苄西林、头孢呋辛、头孢噻肟、氯霉素、甲氧苄啶的耐药性降低,mel-sf2013004/bj对氯霉素的耐药性降低;志贺菌mel-sf1998024/zz和mel-sf2013004/bj经无抗生素压力传代后,CRISPR3位点3''的重复-间隔序列丢失,其中间隔序列匹配基因的编码产物是Cas蛋白。结论 志贺菌在无抗生素压力下,可降低或丢失对某些抗生素的耐药性。部分志贺菌CRISPR3位点的结构发生了变化,CRISPR3位点与cas基因可能存在共进化。     

8种氨基糖苷类抗生素FDNB衍生化产物的电喷雾离子阱质谱及色谱行为研究

 目的 采用电喷雾离子阱质谱（ESI-MSn法研究8种氨基糖苷类抗生素2,4-二硝基氟苯（FDNB衍生化产物的质谱裂解规律及色谱行为。方法 分别取氨基糖苷类抗生素FDNB衍生化产物溶液,将其直接导入ESI离子源进行分析。结果 在正离子检测方式下,各化合物在二级质谱分析时,均可发生A环与B环之间的糖苷键断裂,生成脱去A环的碎片离子;在三级质谱分析时,进一步发生B环与C环之间的糖苷键断裂,生成脱去B环或C环的碎片离子。新霉素B由4个环组成,在三级质谱分析时,其衍生化产物发生B环与C环之间的糖苷键断裂,主要生成脱去B环的碎片离子;在四级质谱分析中,进一步生成脱去C环或D环的碎片离子。结论 通过LC-MS/MS和HPLC-UV分析获得了氨基糖苷类抗生素FDNB衍生化产物的色谱行为信息,为该类药物分析方法（HPLC-UV和LC-MS/MS的建立和结构解析提供依据。