三种固定方式在预防PICC导管性压疮中的效果比较

目的:探讨预防PICC导管性压疮的方法.方法:195例患者随机分为对照组、观察1组、观察2组,每周维护一次(前后误差±1天).对照组采用普通固定方式,观察1组采用无菌纱布垫在导管固定连接器与皮肤接触位置,观察2组采用免缝胶带R1547"Ω"固定法固定导管固定连接器与皮肤接触位置,相互观察对照,比较三组导管性压疮的发生率.结果:三组之间两两比较,差异有统计学意义(P<0.05),导管性压疮发生率对照组>观察2组>观察1组.结论:使用免缝胶带R1547"Ω"固定法优于其他两组,能有效预防PICC导管性压疮的发生,建议选用.     

一次性使用无菌导尿管(包)包装标志问题探讨

针对目前市售一次性使用导尿管(包)的包装标志存在的问题进行了汇总,分析了其危害性,并提出了改进的建议。     

Ischemic-reperfusion syndromes: biochemical and immunologic rationale for IL-1 targeted therapy

Ischemic-reperfusion injury (IRI) can affect many organ systems. Examples include strokes, coronary occlusion, accidental hypothermia, compartment syndrome and neonatal hypoxia. To date no mechanism has been fully accepted to explain acute inflammation associated with IRI. There is circumstantial evidence from animal and human ex-vivo cardiac experiments to support the hypothesis that acute inflammation associated with IRI is in part caused by IL-1β and/or IL-1 α secretion. Danger signal formation, such as uric acid/calcium pyrophosphate crystallization and other cellular stresses, may occur in IRI. These in turn may stimulate innate immune pathways (i.e. cryopyrin-inflammasome; and/ or toll-like receptors 2 and 4) to secrete IL-1 β. Most IL-1 targeted therapy studies have focused on chronic human diseases and hopefully this discussion will create a framework to encourage use of this therapy in acute inflammation associated with IRI.     

妊娠期单核细胞增多性李斯特菌感染并文献复习

目的探讨妊娠期孕妇单核细胞增多性李斯特菌(LM)感染的临床特征、围生结局及临床处理经验。 方法选择2016年11月1日与2017年2月28日,四川大学华西第二医院产科收治的2例LM感染孕妇为研究对象。采用回顾性分析方法,对这2例LM感染孕妇的临床病例资料进行分析,包括妊娠期情况、妊娠期LM感染诊治情况及围生期结局。同时,结合相关文献,对妊娠期LM感染的生物学及流行病学特征、诊断及处理、对母儿的影响,以及防治措施,进行复习、总结。 结果①本组2例LM感染孕妇的妊娠期情况为：No.1孕妇于本院建卡,No.2孕妇于外院建卡,2例孕妇均于建卡医院接受正规产前检查,均有巴氏消毒牛奶食用史,入本院治疗前,均出现发热等上呼吸道感染症状,血常规检查结果均异常。②妊娠期LM感染诊治情况：No.1孕妇通过宫颈分泌物培养结果提示中量LM感染,确诊为妊娠期LM感染;No.2孕妇通过血培养及产时取宫颈分泌物培养结果提示LM呈阳性,确诊为妊娠期LM感染。2例孕妇均接受足够剂量美罗培南(1 g/次×3次/d×14 d)抗感染治疗后,预后良好,并出院。③围生期结局：No.1孕妇于晚孕期发生LM感染,因早产临产、胎儿宫内窘迫,进行急诊剖宫产分娩术,其分娩的新生儿血培养及痰培养结果均提示LM呈阳性。因该例新生儿并发症多、病情危重,家属放弃抢救,于出生后第9天死亡。No.2孕妇于中孕期发生LM感染,胎死宫内后难免流产。 结论孕妇LM感染临床症状无特异性,常伴有发热,表现为流感样症状,临床诊断较为困难,但是孕妇LM感染对胎儿及新生儿有致命危险。因此,临床提高对妊娠期LM感染的认识,早期诊断、早期积极有效治疗,可明显改善妊娠期LM感染母儿预后。     

Strategies to Mitigate Establishment under the Wolbachia Incompatible Insect Technique

The Incompatible Insect Technique (IIT) strategy involves the release of male mosquitoes infected with the bacterium Wolbachia. Regular releases of male Wolbachia-infected mosquitoes can lead to the suppression of mosquito populations, thereby reducing the risk of transmission of vector-borne diseases such as dengue. However, due to imperfect sex-sorting under IIT, fertile Wolbachia-infected female mosquitoes may potentially be unintentionally released into the environment, which may result in replacement and failure to suppress the mosquito populations. As such, mitigating Wolbachia establishment requires a combination of IIT with other strategies. We introduced a simple compartmental model to simulate ex-ante mosquito population dynamics subjected to a Wolbachia-IIT programme. In silico, we explored the risk of replacement, and strategies that could mitigate the establishment of the released Wolbachia strain in the mosquito population. Our results suggest that mitigation may be achieved through the application of a sterile insect technique. Our simulations indicate that these interventions do not override the intended wild type suppression of the IIT approach. These findings will inform policy makers of possible ways to mitigate the potential establishment of Wolbachia using the IIT population control strategy.     

Characterization of oxacillin-resistant Staphylococcus lugdunensis isolated from sterile body fluids in a medical center in Taiwan: A 12-year longitudinal epidemiological study

BackgroundIn this study, our objective was to characterize Staphylococcus lugdunensis isolated from sterile body fluids (SBFs) in a medical center in Taiwan between 2009 and 2020.MethodsWe used MALDI-TOF MS, disk diffusion testing, agar dilution assay, SCCmec typing, and antibiotic resistance gene screening to identify and investigate the characteristics of oxacillin-resistant S. lugdunensis (ORSL).ResultsA total of 438 S. lugdunensis isolates were collected and 146 (33.3%) isolates were identified as ORSL. SCCmec type V was dominant (65.7%) in our ORSL isolates, followed by SCCmec type II (18.5%), and type IV (8.9%). After 2013, a slight increase in SCCmec types IV and V was revealed. Moreover, all ORSL isolates with type II and untypable SCCmec were highly resistant to oxacillin (MIC >32 μg/mL), compared to ORSL that had SCCmec types IV, V, and VT. All 146 ORSL isolates were resistant to penicillin and susceptible to teicoplanin and vancomycin. High resistance rates of ORSL to clindamycin (43.2%), erythromycin (43.2%), gentamicin (78.1%) and tetracycline (46.6%) was observed. Moreover, only two (1.4%) and six (4.1%) ORSL isolates were resistant to trimethoprim/sulfamethoxazole and ciprofloxacin, respectively. The erythromycin-resistant ORSL isolates mostly exhibited constitutive MLS_B resistant phenotype (61/63, 96.8%) and contained either ermC alone (27/63, 42.9%) or a combination of ermC with ermA (28/63, 44.4%).ConclusionOur present study showed a stable rate of ORSL from SBFs during 2009–2020. Moreover, teicoplanin, vancomycin, trimethoprim/sulfamethoxazole, and ciprofloxacin were shown to be highly efficient for the treatment of ORSL in vitro.     

New uses for an old remedy: Digoxin as a potential treatment for steatohepatitis and other disorders

Repurposing of the widely available and relatively cheap generic cardiac gly-coside digoxin for non-cardiac indications could have a wide-ranging impact on the global burden of several diseases. Over the past several years, there have been significant advances in the study of digoxin pharmacology and its potential non-cardiac clinical applications, including anti-inflammatory, antineoplastic, metabolic, and antimicrobial use. Digoxin holds promise in the treatment of gastrointestinal disease, including nonalcoholic steatohepatitis and alcohol-associated steatohepatitis as well as in obesity, cancer, and treatment of viral infections, among other conditions. In this review, we provide a summary of the clinical uses of digoxin to date and discuss recent research on its emerging applications.     

Pharmacy practice in hospital settings in GCC countries: Dispensing and administration

PurposeTo outline dispensing and administration practices in hospital pharmacy across the Gulf Cooperation Councils (GCC) countries’ hospitals. Paucity of data in appraising hospital pharmacy practice in GCC regions motivated us to conduct this study.MethodsA modified survey questionnaire was prepared from the American Society of Health-System Pharmacist (ASHP) survey questions. Three major domains of questions for general characteristics of the medication use process for dispensing and administration were identified. These were, (1) medication distribution system, and medication distribution technology, (2) technology used to compound sterile preparations, compounding I.V. medication and method of compounding nutrition support preparations, (3) medication administration practices, medication orders, medication administration records (MARs), and technician activities. A list of hospitals was obtained from the Ministry of Health of the targeted GCC countries. A secure invitation link containing a survey questionnaire was sent to the participants directly.ResultsSixty-four hospitals responded to this survey. The overall response rate was 52%. Most surveyed hospitals have centralized inpatient medications distribution system (75.0%). About 37.5% of hospitals used automated dispensing cabinets (ADCs) in their patient care areas. Compounding sterile preparations in the pharmacy, barcode verification technology, workflow management technology, and robotic technology were used by 17.2%, 15.6%, and 4.7% of hospitals, respectively. In using safety technology for medication administration, almost all hospitals have partially or completely implemented an electronic health record (EHR). About 40.6% of hospitals used electronic medication administration records (e-MARs), 20.3% used bar-code-assisted medication administration (BCMA), and 35.9% used smart infusion pumps.ConclusionThe results of this survey revealed an opportunity to improve the medication use management process on dispensing and administration practices in hospitals in GCC countries.