如何防止灭菌化学指示卡监测中的失误

压力蒸气灭菌化学指示卡监测是常规使用的灭菌效果监测措施之一，但有其限局性，如指示卡安放位置或监测方法不正确，会产生假性结果，导致判断失误。作者对此进行了试验研究，结果表明：只有在工艺、化学、生物三种监测结果均合格时，方能判定为无菌物品     

A case of primary multidrug-resistant pulmonary tuberculosis with high minimum inhibitory concentration value for bedaquiline

Bedaquiline is a new ATP synthesis inhibitor developed as an anti-tuberculosis agent. It has resistance-associated variants (RAV), regardless of preceding bedaquiline exposure. Herein, we describe the case of a patient with multidrug-resistant tuberculosis (MDR-TB) who had no history of bedaquiline therapy but presented a relatively high minimum inhibitory concentration (MIC) of bedaquiline (1 μg/mL). Whole genome sequencing revealed a mutation in the resistance-associated gene Rv0678. The patient was first treated with a five-drug regimen (bedaquiline, delamanid, levofloxacin, cycloserine, and amikacin), which induced negative sputum culture conversion. Despite the successful treatment outcome, several questions remain regarding the efficacy of bedaquiline in this patient. Bedaquiline is an indispensable drug for MDR-TB treatment, but its clinical efficiency in the presence of Rv0678 mutations remains unclear. Therefore, evaluating the MIC of bedaquiline even in patients without a history of bedaquiline use is important for therapeutic regimen selection and may emphasize the importance of therapeutic drug monitoring in cases of bedaquiline RAV.     

Hypoalbuminemia: Pathogenesis and Clinical Significance

Hypoalbuminemia is associated with inflammation. Despite being addressed repeatedly in the literature, there is still confusion regarding its pathogenesis and clinical significance. Inflammation increases capillary permeability and escape of serum albumin, leading to expansion of interstitial space and increasing the distribution volume of albumin. The half‐life of albumin has been shown to shorten, decreasing total albumin mass. These 2 factors lead to hypoalbuminemia despite increased fractional synthesis rates in plasma. Hypoalbuminemia, therefore, results from and reflects the inflammatory state, which interferes with adequate responses to events like surgery or chemotherapy, and is associated with poor quality of life and reduced longevity. Increasing or decreasing serum albumin levels are adequate indicators, respectively, of improvement or deterioration of the clinical state. In the interstitium, albumin acts as the main extracellular scavenger, antioxidative agent, and as supplier of amino acids for cell and matrix synthesis. Albumin infusion has not been shown to diminish fluid requirements, infection rates, and mortality in the intensive care unit, which may imply that there is no body deficit or that the quality of albumin “from the shelf” is unsuitable to play scavenging and antioxidative roles. Management of hypoalbuminaemia should be based on correcting the causes of ongoing inflammation rather than infusion of albumin. After the age of 30 years, muscle mass and function slowly decrease, but this loss is accelerated by comorbidity and associated with decreasing serum albumin levels. Nutrition support cannot fully prevent, but slows down, this chain of events, especially when combined with physical exercise.     

青浦区三家二级医院抗菌药物临床应用情况评价指标的建立与实践

目的建立合适的抗菌药物(AMD)评价指标,快速、可靠地评价青浦区二级医院内AMD使用的主要问题。方法依据16项国际抗菌药物使用调研指标,以及联合用药调研指标,采用回顾性数据收集和分析方法对该地区三家二级医院的住院患者进行抽样调研。结果医院基本药物目录中有62种AMD,但缺乏成文的药物治疗指南性文件,住院处方中有≥应用1种AMD的住院患者数占住院患者总数的69.59%;处方平均2.49种AMD;每位患者的使用AMD平均费用是879.74元;AMD治疗患者非预防Ⅰ、Ⅱ类切口感染的平均天数是6.33d;77.39%手术患者接受AMD预防感染,平均次数为14.27次;26.08%的肺炎病例按照指导原则治疗;以通用名开AMD处方的百分率为89.91%;仅有17.38%的AMD治疗患者进行了病原体药敏试验。结论医院决策层及药事管理委员会对AMD监管力度仍嫌不足,处方者对AMD的规范性使用意识薄弱,药师仍需发挥更大的合理用药促进作用。     

Electrodeless, accurate pH determination in highly basic media using a new set of (1)H NMR pH indicators

A set of indicator molecules was selected and applied to elaborate an NMR-based pH determination method, free of glass electrode errors in highly basic media. Accurate measurement of pH values and protonation constants was achieved by a successive build-up of overlapping, increasingly high pH solutions, using a collection of 8 compounds of appropriately incremented basicities. In order to verify the method, acid-base properties were quantified for two compounds with very high basicities in conflicting reports: two pharmaceutically important biguanidine drugs, metformin and phenformin.     

统分结合测量居民幸福指数

针对已有幸福指数测量方法中的两个主要缺点,借鉴幸福指数单测法的合理成分,由幸福分数构成幸福指数的综合指标。依据马斯洛需要层次理论,由生存需要满足层次的幸福指数、安全需要满足层次的幸福指数、社交需要满足层次的幸福指数、尊重需要满足层次的幸福指数和自我实现需要满足层次的幸福指数这样五个一级指标以及23个二级指标构成幸福指数的分指标。居民幸福指数统分结合测量具有独特的优势和功能。     

A study of tubercular lymphadenitis: a comparison of various laboratory diagnostic modalities with a special reference to tubercular polymerase chain reaction

Objective: The purpose of our study was to compare various laboratory diagnostic methods, namely histopathological examination, Ziehl-Neelsen (ZN) stain, AFB culture by conventional Lowenstein–Jensen (LJ) method and fluorescence-based mycobacterial growth indicator tube (MGIT) technique and polymerase chain reaction (PCR) in clinically suspected cases of tubercular lymphadenitis. Materials and Methods: A total of 65 lymph nodes biopsied from patients clinically suspected of having tubercular lymph nodes were included. Specimens were processed for AFB culture after NaOH-NALC concentration and inoculation on LJ medium and using the MGIT system. PCR was performed on all specimens using a commercial nested PCR kit targeting IS6110 insertion element of Mycobacterium tuberculosis complex. All lymph node specimens were subjected to histopathological examination. Results: Of the 65 lymph nodes, 37 (56.9%) were positive on MGIT culture and 45 (69.2%) were positive by PCR. Histopathology showed maximum sensitivity (96%) but with compromised specificity (78.5%). PCR showed 90.1% sensitivity and 100% specificity. The mean turnaround time for mycobacterial growth in smear negative specimens was 30 days determined by LJ and 20 days by MGIT techniques. Conclusion: PCR is a rapid and useful method for diagnosis of TB lymphadenitis and definitely increases the positive predictive value of a positive histopathology report. MGIT is better than LJ culture as regards time to positivity and higher yield.