Molecular epidemiological analysis of the acinetobacter baumannii isolates from blood and sputum specimens of patients with ventilator-associated pneumonia北大核心CSCD

Objective To investigate the molecular epidemiological characteristics of the Acinetobacter baumannii strains isolated from blood and sputum samples of patients with ventilator-associated pneumonia (VAP) in ICU. Methods The patients were analyzed in two groups: Group A, A. baumannii was isolated from both blood and sputum, and Group B, A. baumannii was isolated only from sputum. Clinical data of the patients were collected, including the results of antimicrobial susceptibility test. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were performed for the strains. Results During the study period from June 2015 to December 2105, 28 nonduplicate A. baumannii strains were collected from 14 patients in group A and 28 nonduplicate strains from 28 patients in group B. The 56 A. baumannii strains were multidrug-resistant (MDR). More than 80% of the strains were resistant to carbapenem, third-generation cephalosporins or aminoglycoside, but highly sensitive to tigecycline. No significant difference was found for the resistance rates between group A and group B. The nonduplicate A. baumannii isolates from blood and sputum samples of the same patient in group A were all homologous strains confirmed by PFGE. Six pulsotypes were identified from the 28 strains in Group A and 9 pulsotypes in Group B. Five pulsotypes were shared between the two groups. MLST analysis showed that there were 9 ST types (ST195, ST208, ST229, ST369, ST373, ST457, ST836 and two new phenotypes ST N2, ST N5) in Group A and 8 ST types (ST195, ST208, ST381 and 5 new phenotypes ST N1, ST N2, ST N3, ST N4, ST N5) strains in group B. There was no significant difference in the proportion of the main ST types between the two groups. eBURST analysis indicated that ST195, ST208, ST457, ST369, ST N1, ST N2, ST N51 belonged to CC92 prevalent strain. Conclusions The antimicrobial susceptibility profile and genotype of A. baumannii isolates from blood and sputum samples are similar. There was CC92 prevalent strain in the ward. There is no direct relation between the risk factors for bloodstream infection in VAP patients and the genotype of A. baumannii strain. It is particularly important to reinforce infection control for prevention and treatment of A. baumannii bloodstream infections. © 2018, Editorial Department of Chinese Journal of Infection. All rights reserved.     

Safety and immunogenicity of high-dose trivalent inactivated influenza vaccine in adults 50–64 years of age

BackgroundIndividuals 50–64 years of age have reduced immune responses to influenza vaccines. The current study examined whether a high-dose inactivated trivalent influenza vaccine (IIV3-HD) might improve immune responses over a standard-dose inactivated influenza vaccine (IIV3-SD) in this age group.MethodsThis was a multicenter, observer-blinded, randomized, active-controlled phase II trial. Adults 50–64 years of age were randomized 1:1 to receive IIV3-HD or IIV3-SD. Hemagglutination inhibition titers were measured before and 28 days after vaccination. Reactogenicity was recorded for 7 days after vaccination and adverse events for 28 days.Results148 participants received IIV3-HD and 152 received IIV3-SD. For all vaccine strains, day 28 geometric mean hemagglutination inhibition titers were significantly higher in the IIV3-HD group than in the IIV3-SD group (geometric mean titer ratio [95% confidence interval (CI)] = 1.43 [1.04–1.97] for A/H1N1, 1.65 [1.21–2.25] for A/H3N2, and 1.60 [1.23–2.08] for B). Seroconversion rates were significantly higher in the IIV3-HD group than in the IIV3-SD group for strains A/H3N2 and B but not A/H1N1 (difference [95% CI] = 13.5% [4.76–22.0] for A/H3N2, 23.1% [11.7–33.6] for B, and −0.2% [−9.66 to 9.18] for A/H1N1). The post-vaccination seroprotection rate was significantly higher in the IIV3-HD group than in the IIV3-SD group for strain B but not for strains A/H1N1 or A/H3N2 (difference = 9.1% [2.95–15.7] for B, 2.0% [−0.907 to 5.68] for A/H1N1, and 0.6% [−3.14 to 4.43] for A/H3N2). Reactogenicity was higher in the IIV3-HD group than in the IIV3-SD group, but reactions were mostly of low intensity, transient, and self-limited. Rates of unsolicited adverse events were similar between groups. No serious AEs, AEs leading to early withdrawal, or deaths were reported.ConclusionsThe study suggests that in adults 50–64 years of age, IIV3-HD may improve immunogenicity compared to IIV3-SD while maintaining an acceptable safety profile.     

阻塞性睡眠呼吸暂停综合征40例发病特点分析

目的：探讨阻塞性睡眠呼吸暂停综合征（ OSAS）患者的临床发病特点。方法选取2012年5月至2013年8月在我院呼吸科诊断治疗的40例OSAS患者作为观察组,另外选取40例健康成年人作为对照组,观察纳入的80例患者血清中瘦素（ leptin）、C反应蛋白水平（ CRP）及基础病种,分析OSAS患者的临床发病特点。结果与对照组比较,观察组患者多有肥胖、心脑血管疾病等原发性疾病,观察组患者血清中瘦素及C反应蛋白水平[（170．16±19．77）ng／L,（20．78±4．39）μg／L]明显高于对照组组[（51．97±8．68）ng／L,（4．35±0．92）μg／L],差异均有统计学意义（P＜0．05或＜0．01）。结论 Leptin及CRP水平可以较好的反映OSAS患者的严重程度相关,两者可能在OSAS的发展过程中有协同作用。     

经肛三联术治疗三度直肠脱垂的临床效果分析

目的：探究分析经肛三联术来治疗患有三度直肠脱垂患者的临床疗效。方法采用回顾性分析的方法,分析了78例患有三度直肠脱垂患者的临床资料,根据治疗方法的不同,将其分为对照组和实验组（n=39）,对照组选择常规手术进行治疗,实验组选择经肛三联术式予以治疗,观察2组患者的治疗情况以及术中术后情况。结果实验组的治疗总有效率达97.44%,明显高于对照组的治疗总有效率79.49%,差异有统计学意义（P<0.05）;且实验组术中出血量明显比对照组少（P<0.05）,并发症出现概率也明显减少。结论经肛三联手术可以有效治疗三度直肠脱垂,减轻患者的痛苦,提高治疗有效率,减少术中出血量,降低并发症等危险发生,应值得临床广泛推广应用。     

脑梗死并发肺炎患者舒血宁治疗及护理疗效观察

目的 探究急性脑梗死患者使用舒血宁注射液治疗前后的疗效,并进一步探究患者在住院期间并发肺炎后的临床护理.方法 对纳入该院神经内科因急性脑梗死住院治疗并发肺炎患者77例,根据临床上使用药物的不同,分为舒血宁组和对照组,舒血宁组38例,对照组39例.并对患者进行住院后第一天、第七天及第十四天体内血清高敏C反应蛋白采用免疫比浊法进行检测,及疗效评估和肺炎并急性脑梗死的临床护理.结果 ①治疗后舒血宁组和对照组间血清高敏C反应蛋白水平存在差异,治疗后第十四天,舒血宁组高敏C反应蛋白水平显著低于对照组,差异有统计学意义(P＜0.05).②二组疗效比较发现,舒血宁组的总有效率高于对照组(P＜0.05).③合适的临床护理有助于患者病情的恢复.结论 舒血宁治疗脑梗死并发肺炎患者疗效显著,可能通过抗炎途径发挥作用,适当的临床护理有助于患者病情恢复.     

SGLT2 inhibitors: are they safe?

Sodium–glucose linked transporter type 2 (SGLT2) inhibitors are a relatively new class of antidiabetic drugs with positive cardiovascular and kidney effects. The aim of this review is to present the safety issues associated with SGLT2 inhibitors. Urogenital infections are the most frequently encountered adverse events, although tend to be mild to moderate and are easily manageable with standard treatment. Although no increased acute kidney injury risk was evident in the major trials, the mechanism of action of these drugs requires caution when they are administered in patients with extracellular volume depletion or with drugs affecting renal hemodynamics. Canagliflozin raised the risk of amputations and the rate of fractures in the CANVAS trial, although more data are necessary before drawing definite conclusions. The risk of euglycemic diabetic ketoacidosis seems to be minimal when the drugs are prescribed properly. Regarding other adverse events, SGLT2 inhibitors do not increase the risk of hypoglycemia even when co-administered with insulin, but a decrease in the dose of sulphonylureas may be needed. The available data do not point to a causative role of SGLT2 inhibitors on malignancy risk, however, these drugs should be used with caution in patients with known hematuria or history of bladder cancer. SGLT2 inhibitors seem to be safe and effective in the treatment of diabetes but more studies are required to assess their long-term safety.     

Deconstructing the Pharmacovigilance Hype Cycle

Data science is making increasing contributions to pharmacovigilance. Although the technical innovation of these works are indisputable, efficient progress in real-world pharmacovigilance signal detection may be hampered by corresponding technology life cycle effects, with a resulting tendency to conclude that, with large enough datasets and intricate algorithms, “the numbers speak for themselves,” discounting the importance of clinical and scientific judgment. A practical consequence is overzealous declarations regarding the safety or lack of safety of drugs. We describe these concerns through a critical discussion of key results and conclusions from case studies selected to illustrate these points.     

Automated clinical trial eligibility prescreening: increasing the efficiency of patient identification for clinical trials in the emergency department

Objectives (1) To develop an automated eligibility screening (ES) approach for clinical trials in an urban tertiary care pediatric emergency department (ED); (2) to assess the effectiveness of natural language processing (NLP), information extraction (IE), and machine learning (ML) techniques on real-world clinical data and trials.Data and methods We collected eligibility criteria for 13 randomly selected, disease-specific clinical trials actively enrolling patients between January 1, 2010 and August 31, 2012. In parallel, we retrospectively selected data fields including demographics, laboratory data, and clinical notes from the electronic health record (EHR) to represent profiles of all 202795 patients visiting the ED during the same period. Leveraging NLP, IE, and ML technologies, the automated ES algorithms identified patients whose profiles matched the trial criteria to reduce the pool of candidates for staff screening. The performance was validated on both a physician-generated gold standard of trial–patient matches and a reference standard of historical trial–patient enrollment decisions, where workload, mean average precision (MAP), and recall were assessed.Results Compared with the case without automation, the workload with automated ES was reduced by 92% on the gold standard set, with a MAP of 62.9%. The automated ES achieved a 450% increase in trial screening efficiency. The findings on the gold standard set were confirmed by large-scale evaluation on the reference set of trial–patient matches.Discussion and conclusion By exploiting the text of trial criteria and the content of EHRs, we demonstrated that NLP-, IE-, and ML-based automated ES could successfully identify patients for clinical trials.     

Transformation of standardized clinical models based on OWL technologies: from CEM to OpenEHR archetypes

Introduction The semantic interoperability of electronic healthcare records (EHRs) systems is a major challenge in the medical informatics area. International initiatives pursue the use of semantically interoperable clinical models, and ontologies have frequently been used in semantic interoperability efforts. The objective of this paper is to propose a generic, ontology-based, flexible approach for supporting the automatic transformation of clinical models, which is illustrated for the transformation of Clinical Element Models (CEMs) into openEHR archetypes.Methods Our transformation method exploits the fact that the information models of the most relevant EHR specifications are available in the Web Ontology Language (OWL). The transformation approach is based on defining mappings between those ontological structures. We propose a way in which CEM entities can be transformed into openEHR by using transformation templates and OWL as common representation formalism. The transformation architecture exploits the reasoning and inferencing capabilities of OWL technologies.Results We have devised a generic, flexible approach for the transformation of clinical models, implemented for the unidirectional transformation from CEM to openEHR, a series of reusable transformation templates, a proof-of-concept implementation, and a set of openEHR archetypes that validate the methodological approach.Conclusions We have been able to transform CEM into archetypes in an automatic, flexible, reusable transformation approach that could be extended to other clinical model specifications. We exploit the potential of OWL technologies for supporting the transformation process. We believe that our approach could be useful for international efforts in the area of semantic interoperability of EHR systems.