Faecal carriage of extended‐spectrum β‐lactamase‐producing Enterobacteriaceae among humans in Java,Indonesia, in 2001–2002

Objective To characterise commensal Escherichia coli and other Enterobacteriaceae with reduced susceptibility to cefotaxime that were collected in a large survey carried out among 3995 patients and healthy persons in two urban regions on Java, Indonesia, in 2001–2002. Methods The putative extended‐spectrum β‐lactamase (ESBL)‐producing Enterobacteriaceae were analysed using double‐disk synergy tests, isoelectric focusing, PCR assays, DNA sequencing, and pulsed‐field gel electrophoresis (PFGE). Results On the day of discharge after five or more days of hospitalisation, at least 95 of 999 (9.5%) patients carried ESBL‐positive Enterobacteriaceae as dominant faecal flora. Six patients were simultaneously colonised with E. coli and Klebsiella pneumoniae isolates with ESBL activity. On admission, only 6 of 998 (0.6%) patients were colonised. Faecal carriage of ESBL‐producing Enterobacteriaceae among healthy persons or persons visiting a public health centre was not detected. The 107 ESBL‐positive strains included 68 E. coli, 35 K. pneumoniae, and four other Enterobacteriaceae. bla_CTX‐M‐15 was the most prevalent ESBL in both E. coli (47.1%) and K. pneumoniae (45.7%), but the E. coli O25b‐ST131 clone was virtually absent. Other ESBL types found were: SHV‐2, ‐2a, ‐5, ‐12, CTX‐M‐3, ‐9, ‐14, and TEM‐19. PFGE revealed extensive genetic diversity among the isolates. Conclusions In 2001–2002, faecal carriage of ESBL‐producing Enterobacteriaceae as dominant flora in Indonesia was almost exclusively hospital‐associated. The presence of various bla_ESBL genes and the extensive genetic diversity among isolates argue against a single/dominant strain outbreak.     

有机锗（Ge—132）增强环磷酰胺抗瘤作用的实验研究

本文观察了有机锗在试验治疗荷移植肝癌小鼠中增强血清超氧化物歧化酶活性及细胞免疫的作用，增强环磷酰胺抗移植肝癌作用以及它本身抗移植肝癌的效果，结果是：高剂量Ｇｅ－１３２（１２．５ｍｇ／次）治疗组的抑癌率为３１％，移植肝癌ＷＢＣ浸润者为７２．７％，血清ＳＯＤ活性分别是３６．４％，８１Ｎｕ／ｍｌ，两组比较差异显著（Ｐ〈０．０５），ＣＴＸ组的抑癌率是３７％，癌体ＷＢＣ浸润者为２７．３％，血清ＳＯＤ活性为１     

Multifocal,hypoechogenic nerve thickening in Cerebrotendinous Xanthomatosis

ObjectiveTo characterize peripheral nerve morphology in cerebrotendinous xanthomatosis (CTX) patients using high-resolution ultrasound (HRUS) in vivo. We hypothesized that nerve enlargements might be present in CTX as a result of accumulation of abnormal lipids with deposition also in peripheral nerves.MethodsFour CTX patients were examined using HRUS to assess morphological abnormalities of peripheral nerves as well as cervical nerve roots 5 and 6.ResultsHRUS revealed mild to moderate, hypoechogenic thickening of sensorimotor nerves (ulnar nerve in 1/4, tibial nerve in 3/4, median nerve 4/4 patients) as well as mild enlargement of pure sensory nerves (sural nerve in 2/3, superficial FN in 2/4 patients). The vagal nerve was moderately enlarged in one patient, cervical roots showed moderate enlargements of C5 in two patients, one of which also showing thickening of C6 as well as in another patient. UPSS score was slightly to moderately abnormal in all patients. The Homogeneity score was not increased suggesting regional to inhomogeneous nerve enlargement.ConclusionsHRUS shows multifocal, hypoechogenic nerve thickening of peripheral nerves and nerve roots in CTX.SignificanceHRUS might serve as a valuable, additive and non-invasive bedside tool to assess peripheral nerve morphology in future clinical studies on CTX patients.     

环磷酰胺冲击治疗难治性肾病综合征34例护理体会

目的:探讨环磷酰胺(CTX)冲击治疗难治性肾病综合征(RNS)的疗效及护理方法.方法:将68例RNS患者随机分为治疗组与对照组各34例,对照组采用强的松、洛汀新、潘生丁等治疗,治疗组在以上治疗的基础上加用CTX冲击治疗,并在治疗的前、中、后期实施不同的护理干预.结果:治疗组总有效率为85.29%,对照组为58.82%;治疗组1年内复发率为24.14%,时照组为65.00%.两组比较均有极显著性差异(P＜0.01).结论:CTX冲击治疗RNS效果满意,在冲击治疗的各个时期分别实施不同的护理干预,有助于减轻CTX冲击治疗的副作用,提高疗效,降低RNS复发率.     

老年骨质疏松性骨折患者血清B-ALP、PTH、s-PINP和s-CTX表达

目的 探讨老年骨质疏松性骨折(OPF)患者血清骨特异性碱性磷酸酶(B-ALP)、甲状旁腺激素(PTH)、I型前胶原氨基端前肽(s-PINP)和I型胶原羧基端交联肽(s-CTX)水平及临床意义.方法 选取2019年3月至2020年3月本院收治76例老年OPF患者作为OPF组,同期收治80例未发生骨折骨质疏松症(OP)患者...     

Morphological damage to the premature fetal rat brain after acute carbon monoxide exposure

For most brain regions the responses of neurons to stimulation of the primary visual cortex (CTX) are unknown. The objective of this study was to determine how neurons (single-unit activity) in major limbic, thalamic, hypothalamic, and visual regions respond to electrical stimulation of the CTX. Cats underwent low cerveau isolé surgery (isolate forebrain) and electrode implantation. Unit activity was analyzed as action potentials recorded extracellularly under control (spontaneous firing rate) and experimental (poststimulus rate) conditions. A total sample of 2055 units were localized anatomically. The effect of CTX stimulation was primarily inhibitory in the initial 500-ms poststimulus responses. Only 20 cells (<1%) showed initial excitatory responses. Highly responsive regions included areas 17, 18, 19 and the hippocampal formation. Subcortical regions which showed marked (P < 0.01) inhibitory responses form part of the ascending reticular system (anterior, intralaminar, and reticular thalamic nuclei, and tegmental nucleus). Similar effects were also observed in the anteromedial hypothalamus. Only two regions showed significant (P < 0.05) prolonged responses (1 to 5 s) to CTX stimuli. One of them, the prostriatal cortex, exhibited increases in firing rates. The other, the cingulate cortex, showed inhibitory initial and prolonged responses. Therefore, information provided by CTX stimulation is distributed to different limbic and subcortical targets. We suggest that the mechanisms responsible for the effects of visual stimuli on arousal and emotion may be mediated by inhibition of ascending reticular pathways.     

Serum and plasma fragments of C-telopeptides of type I collagen (CTX) are stable during storage at low temperatures for 3 years

BACKGROUND: Control of pre-analytical variables is essential for successful application of biological markers, including bone resorption markers, in clinical trials and routine use. The effect of storage temperature on stability of bone resorption markers have not been subject of systematically investigation, and therefore the present study was set out to determine the stability of C-telopeptides of type I collagen (CTX) in serum and plasma samples stored frozen for 3 years. METHODS: The serum and plasma levels of CTX were determined in samples aliquoted and stored frozen for up to 3 years. RESULTS: No significant decrease could be detected in neither serum nor plasma samples after 3 years of storage at -20, -80 or -150 degrees C. However, at elevated temperature, i.e. 4 and 37 degrees C, improved stability of CTX was observed in EDTA plasma samples compared to serum. CONCLUSIONS: CTX is stable in frozen serum and plasma samples for up to 3 years. EDTA plasma might be the preferred matrix due to improved stability at elevated temperatures.     

Biochemical markers of bone turnover in tibia fracture patients randomly assigned to growth hormone (GH) or placebo injections: Implications for detection of GH abuse

Context

It has been argued that increased levels of bone remodelling markers are not suitable indicators of GH abuse, as bone injuries per se increase the expression levels of these markers.

Objective

To investigate the impact of a recovering tibia fracture on circulating bone markers in subjects receiving placebo or GH treatment.

Design and setting

A randomised, double-blind, placebo-controlled trial of up to 16 weeks GH treatment, followed by a 16-week washout.

Participants and intervention

Subjects (406 adult males and females) with a tibia fracture were randomly allocated within three days after surgery, to either placebo or GH treatment (15, 30 or 60 μg/kg daily) until fracture healing or 16 weeks after treatment initiation.

Main outcome measures

IGF-I, serum C-terminal telopeptide of type I collagen (CTX), osteocalcin (OST) and bone-specific alkaline phosphatase (BAP) were measured during and after treatment.

Results

Dose-dependent increases were observed in groups receiving GH, and mean levels in the highest GH dose group peaked at eight (IGF-I, CTX) or 12 weeks (OST) after treatment initiation. Statistically significant differences between GH treatment and placebo were seen for IGF-I, CTX and OST in all GH dose groups throughout the treatment period, and persisted until eight (CTX) or 12 (OST) weeks after cessation of treatment.

Conclusion

IGF-I, CTX and OST are suitable candidate markers of prolonged, illicit administration of GH. Furthermore, CTX and OST have potentials to serve as markers also after cessation of GH administration.     

Effects of denosumab on bone turnover markers in postmenopausal osteoporosis

Denosumab, a fully human monoclonal antibody to RANKL, decreases bone remodeling, increases bone density, and reduces fracture risk. This study evaluates the time course and determinants of bone turnover marker (BTM) response during denosumab treatment, the percentage of denosumab‐treated women with BTMs below the premenopausal reference interval, and the correlations between changes in BTMs and bone mineral density (BMD). The BTM substudy of the Fracture REduction Evaulation of Denosumab in Osteoporosis every 6 Months (FREEDOM) Trial included 160 women randomized to subcutaneous denosumab (60 mg) or placebo injections every 6 months for 3 years. Biochemical markers of bone resorption (serum C‐telopeptide of type I collagen [CTX] and tartrate‐resistant acid phosphatise [TRACP‐5b]) and bone formation (serum procollagen type I N‐terminal propeptide [PINP] and bone alkaline phosphatase [BALP]) were measured at baseline and at 1, 6, 12, 24, and 36 months. Decreases in CTX were more rapid and greater than decreases in PINP and BALP. One month after injection, CTX levels in all denosumab‐treated subjects decreased to levels below the premenopausal reference interval. CTX values at the end of the dosing period were influenced by baseline CTX values and the dosing interval. The percentage of subjects with CTX below the premenopausal reference interval before each subsequent injection decreased from 79% to 51% during the study. CTX and PINP remained below the premenopausal reference interval at all time points in 46% and 31% denosumab‐treated subjects, respectively. With denosumab, but not placebo, there were significant correlations between CTX reduction and BMD increase (r = ?0.24 to ?0.44). The BTM response pattern with denosumab is unique and should be appreciated by physicians to monitor this treatment effectively. © 2011 American Society for Bone and Mineral Research.     

Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis: executive summary of recommendations from the American Dental Association Council on Scientific Affairs

BackgroundThis narrative review of osteonecrosis of the jaw in patients with low bone mass receiving treatment with antiresorptive agents is based on an appraisal of the literature by an advisory committee of the American Dental Association Council on Scientific Affairs. It updates the committee’s 2008 advisory statement.MethodsThe authors searched MEDLINE for literature published between May 2008 (the end date of the last search) and February 2011.ResultsThis report contains recommendations based on the findings of the literature search and on expert opinion that relate to general dentistry; periodontal disease management; implant placement and maintenance; oral and maxillofacial surgery; endodontics; restorative dentistry and prosthodontics; orthodontics; and C-terminal telopeptide testing and drug holidays.ConclusionsThe highest reliable estimate of antiresorptive agent–induced osteonecrosis of the jaw (ARONJ) prevalence is approximately 0.10 percent. Osteoporosis is responsible for considerable morbidity and mortality. Therefore, the benefit provided by antiresorptive therapy outweighs the low risk of developing osteonecrosis of the jaw.Clinical ImplicationsAn oral health program consisting of sound hygiene practices and regular dental care may be the optimal approach for lowering ARONJ risk. No validated diagnostic technique exists to determine which patients are at increased risk of developing ARONJ. Discontinuing bisphosphonate therapy may not lower the risk but may have a negative effect on low-bone-mass–treatment outcomes.