The 24-h reporting of Gram stains from positive blood cultures contributes to physician's use of appropriate antimicrobials: Experience at a university hospital

Although recent technological advances for the diagnosis of bloodstream infection (BSI) provide rapid and accurate results, blood culture maintains a key role in the diagnosis of BSI. The objective of this study was to determine whether 24-h reporting by telephone to disclose the suspected microorganism based on the Gram stain morphology from positive blood cultures (first laboratory report) affects a physician's use of appropriate antimicrobials. A total of 627 (14%) out of 4413 blood samples, excluding duplicate samples from the same patient on the same day, were positive for blood cultures between January and December 2016. The contamination rate of blood cultures during the study period was 2.3%. Among 627 patients with positive blood cultures, 538 (86%) were receiving antibiotics at the time of the first laboratory report, of which 502 (80%) thereafter continued the same antimicrobials, and the remaining 36 (6%) were changed to appropriate antimicrobials after the first laboratory report. An additional 25 (4%) were newly administered appropriate antimicrobials after the first laboratory report, whereas an additional 21 (3%) were newly administered appropriate antimicrobials after infection control team (ICT)-intervention. The median time lag (interquartile ranges) from flagging culture bottles as positive to a physician's use of appropriate antimicrobials after the first laboratory report (4 h, 2–7) was significantly (p < 0.001) shorter than that after ICT-intervention (12 h, 10–17). During the study period, no cases of discrepancy between the Gram stain morphology in the first laboratory report and definitive identification of microorganisms in the final laboratory report were observed. Because the timing of flagging culture bottles as positive tends to fall outside normal working hours, immediate 24-h reporting by telephone to disclose the suspected microorganism based on the Gram stain morphology from positive blood cultures may contribute to an early recognition of bacteremia and the physician's use of appropriate antimicrobials.     

大鼠脊髓圆锥损伤后大脑排尿功能区变化的实验研究

目的观察大鼠脊髓圆锥损O24;后大脑排尿功能区结构变化和 Bcl-2 的表达情况，探讨大脑排尿功能区退变的可能因素。方法成年雌性 SD 大鼠 36 只，随机分为实验组（n=30）和对照组（n=6）。实验组将大鼠 L₄ 以下脊神经切断制作脊髓圆锥损O24;模型，对照组不作任何处理。实验组大鼠24b;术全部成功，术后 3、5 个月分别死亡 1 只大鼠，原因可能是肾功能衰竭及尿路感染。实验组于术后 1 d、1 周以及 1、3、6 个月分别处死 6、6、6、5、5 只大鼠，对照组相同时间点各处死 1 只大鼠，取脑桥被盖背外侧部组织，行 HE 染色和 Bcl-2 免疫组织化学 SP 染色观察。 结果HE 染色示，术后 1 d，实验组和对照组无明显区别，神经元细胞密集，排列整齐，核仁清楚；1 周，实验组可见神经元细胞周围间隙稍增宽；1 个月，实验组部分神经元出现细胞核固缩；3、6 个月，实验组细胞核固缩的细胞越来越多，甚至部分细胞出现核消失。Bcl-2 免疫组织化学 SP 染色示，对照组 Bcl-2 表达呈弱阳性。实验组术后 1 d 即出现 Bcl-2 阳性表达，术后 7 d Bcl-2 阳性表达较对照组明显升高，并达高峰，术后 1、3、6 个月 Bcl-2 阳性表达逐渐下降，但仍高于对照组。结论大鼠脊髓圆锥损O24;后大脑排尿中枢出现组织退变、细胞坏死，Bcl-2 表达升高可能与组织修复、大脑功能重塑有关。     

改良经椎间孔入路及后路腰椎椎间融合术治疗中老年轻中度腰椎滑脱症疗效比较

目的比较改良经椎间孔入路腰椎椎间融合术（transforaminal lumbar interbody fusion，TLIF）与后路腰椎椎间融合术（posterior lumbar interbody fusion，PLIF）治疗中老年轻中度腰椎滑脱症的24b;术疗效。方法回顾分析 2015 年 1 月—2017 年 1 月收治的符合选择标准的 106 例轻中度腰椎滑脱症（Meyerding 分度≤Ⅱ度）患者临床资料，根据24b;术方式不同分为改良 TLIF 组（54 例）及 PLIF 组（52 例）。N24;组患者性别、年龄、病程、滑脱椎体、Meyerding 分度及滑脱类型等一般资料比较，差异均无统计学意义（P>0.05）。记录并比较N24;组术中出血量、24b;术时间、术后引流量、术后卧床时间、住院时间、并发症等围术期相关指标。术24d;及术后 1 周，1、6、12 个月，末次随访时采用疼痛视觉模拟评分（VAS）和日本骨科协会（JOA）评分评价疼痛及功能改善情况，术24d;与末次随访时测量滑脱角与椎间隙高度评价椎体滑脱矫正情况，末次随访时根据 Suk 标准R24;定椎间融合情况。 结果240;有患者均获随访，随访时间 A 组 25～36 个月，平均 32.7 个月；B 组 24～38 个月，平均 33.3 个月。改良 TLIF 组术中出血量、24b;术时间、术后引流量、术后卧床时间和住院时间均显著少于 PLIF 组（P<0.05）。N24;组患者术后各时间点 VAS 评分和 JOA 评分均较术24d;显著改善（P<0.05）；术后 1、6 个月改良 TLIF 组 VAS 评分和 JOA 评分显著优于 PLIF 组（P<0.05）。N24;组患者末次随访时滑脱角及椎间隙高度均较术24d;显著改善（P<0.05）；术24d;及末次随访时N24;组间滑脱角及椎间隙高度比较差异均无统计学意义（P>0.05）。末次随访时根据 Suk 标准，改良 TLIF 组椎间融合率为 96.3%（52/54），PLIF 组为 98.1%（51/52），N24;组比较差异无统计学意义（χ²=0.000，P=1.000）。并发症：N24;组患者切口感染、肺部感染及术后 1 周内健侧神经损O24;发生率比较差异均无统计学意义（P>0.05）；改良 TLIF 组均未发生术中硬脊膜损O24;及术后 1 周内患侧神经损O24;，PLIF 组分别发生 4 例（7.7%，P=0.054）和 8 例（15.4%，P=0.002）。 结论改良 TLIF 与 PLIF 24b;术治疗中老年轻中度腰椎滑脱症疗效肯定，改良 TLIF 24b;术对脊柱后柱正常结构损O24;小、出血量和引流量少，硬脊膜和神经损O24;发生率低，可改善术后疼痛，促进患者术后快速康复。     

Lipocalin-2-loaded Amphiphilic Polyanhydride Microparticles Accelerate Cell Migration

This work demonstrates that amphiphilic polyanhydride microparticles based on co-polymers of 1,6-bis(p-carboxyphenoxy)hexane (CPH) and 1,6-bis(p-carboxyphenoxy)-3,6-dioxaoctane (CPTEG) provide stabilizing environments for proteins. A cryogenic atomization method was used to fabricate protein-loaded polyanhydride microparticles. These microparticles were tested for their ability to provide controlled delivery of lipocalin 2 (Lcn2) and to maintain its structure and function. Lcn2 is an acute-phase protein suspected to play a role in cell migration and tissue repair. The in vitro release kinetics of Lcn2 from the microparticles were a function of the chemistry of the polymer carrier. The biological activity of Lcn2 released from polyanhydride microparticles was investigated by its ability to stimulate migration of human colon epithelial cells (HCT116). Lcn2 released from 50:50 and 20:80 CPTEG/CPH microparticles maintained its biological activity as demonstrated by the increased rate of cell migration. In addition, the Lcn2-loaded 50:50 and 20:80 CPTEG/CPH microparticles promoted cell migration over that of the Lcn2 administered alone. This was interpreted as the ability of the amphiphilic microparticles to stabilize the encapsulated protein and release it in a controlled manner over a period of time. This work demonstrates the potential for therapeutic use of amphiphilic polyanhydride microparticles as protein/drug carriers.     

A comprehensive review of intake estimates of di-isononyl phthalate (DINP) based on indirect exposure models and urinary biomonitoring data

Di-isononyl phthalate (DINP) is a high molecular weight general purpose plasticizer used principally in the manufacture of flexible polyvinyl chloride (PVC) articles. DINP metabolites can be measured in biological media such as blood and urine. However, measurement of a substance in the blood or urine does not by itself mean that the chemical causes or is associated with adverse health outcomes. This is particularly pertinent given the advances in modern analytical techniques whereby ever diminishing trace amounts of substances can be detected. Therefore, it is a scientific necessity that risk assessors understand the relationship of biomonitoring data to estimation of exposure so that appropriate comparisons can be made to the no observed adverse effects levels (NOAELs) or other points of departure from toxicological studies in animals. In this paper, estimates of daily DINP intake are calculated for various population segments based on urinary biomonitoring data and are compared to estimates of exposure based on indirect methods and to health-based exposure guidance values. In general, intake estimates converge on a mean of 1–2 μg/kg/day regardless of source of exposure or population cluster; a value 2-orders of magnitude lower than health-based exposure guidance values, ranging from 120 to 290 μg/kg/day, which have been established by regulatory authorities and other authoritative bodies as representing acceptable levels.     

创伤性脑外伤与骨折愈合关系的研究进展

目的总结创O24;性脑外O24;（traumatic brain injury，TBI）对骨折愈合影响机制研究的进展。方法广泛查阅国内外有关 TBI 对骨折愈合影响的文献，并进行总结分析。结果TBI 影响骨折愈合机制复杂，研究方向可大致分为骨折愈合过程中血管生成及骨再生的调节，以及脑外O24;后神经肽及相关激素反应后的局部和全身变化。结论TBI 对骨折愈合起促进作用，其确切作用机制有待进一步研究。     

A prospective study of oesophageal 24-h ambulatory pH monitoring in patients with functional dyspepsia

BACKGROUND: The diagnostic utility of 24-h oesophageal ambulatory pH monitoring in patients with functional dyspepsia has not been well established. AIMS: We performed a prospective study of oesophageal pH monitoring in patients with functional dyspepsia in order to assess whether a positive pH test might predict response to proton pump inhibitor therapy in a subset of functional dyspepsia patients. PATIENTS: Forty Helicobacter pylori-negative functional dyspepsia patients (35 males and 5 females, mean age (+/-S.E.M.) of 54+/-2.4 years) with predominantly unspecified dyspepsia subtype and normal distal oesophageal biopsies. METHODS: All subjects were randomised in a double-blind fashion to either omeprazole 20 mg/day or placebo daily for four weeks after 24-h pH monitoring. RESULTS: Twenty-four-hour pH monitoring was abnormal in 9 of the 21 patients (43%) in the omeprazole group and 5/19 (26%) of the placebo group (p=NS). Patients who reported symptomatic improvement on the Gastrointestinal Symptom Rating Scale were no more likely to have abnormal scores on pH monitoring than patients who did not have symptomatic response. CONCLUSIONS: Although approximately one-third of functional dyspepsia patients will have abnormal profiles on 24-h ambulatory oesophageal pH monitoring, an abnormal score does not appear to predict response to proton pump inhibitor therapy in patients with unspecified functional dyspepsia.