New polymyxin derivatives that display improved efficacy in animal infection models as compared to polymyxin B and colistin

Polymyxin B and colistin (polymyxin E) are bactericidal pentacationic lipopeptides that act specifically on Gram‐negative bacteria, first by disrupting their outermost permeability barrier, the outer membrane (OM), and then damaging the cytoplasmic membrane. The discovery of both polymyxin B and colistin was published independently by three laboratories as early as in 1947. They were subsequently used in intravenous therapy. Unfortunately, they also exhibit significant and dose‐limiting nephrotoxicity. Therefore, polymyxins were reserved as agents of last‐line defense. The emergence of extremely multiresistant strains has now forced clinicians to reinstate polymyxins in the therapy of severe infections. However, the current dosage regimens lead to insufficient drug concentrations in serum and clinicians have been advised to use larger doses, which further increases the risk of nephrotoxicity. Very recently, the interest in developing better tolerated and more effective polymyxins has grown. This review focuses on describing four development programs that have yielded novel derivatives that are more effective than the old polymyxins in animal infection models. Compounds from three programs are superior to the old polymyxins in the rodent lung infection model with Acinetobacter baumannii and/or Pseudomonas aeruginosa. One of them is also more effective than polymyxin B in A. baumannii mouse thigh infection. The fourth program includes compounds that are approximately tenfold more effective in Escherichia coli murine pyelonephritis than polymyxin B.     

急性阑尾炎62例临床分析

目的：探讨急性阑尾炎手术治疗的临床疗效。方法对2010年1月—2012年12月住院治疗急性阑尾炎62例患者的临床资料进行回顾性分析。结果57例手术切除阑尾患者中,55例切口Ⅰ期愈合,2例因阑尾穿孔引起腹膜炎,切口延期愈合;5例保守治疗患者均痊愈。住院8 d ~18 d,平均10.5 d,无严重并发症发生。结论急性阑尾炎手术治疗应依据个体化原则,选择适合患者情况的治疗方法,是提高临床疗效的重要因素。     

危重患者急性胃肠损伤早期肠康复的效果评价

目的 评价对急性胃肠损伤(AGI)患者进行早期肠康复的效果,提出进一步完善的意见.方法 调查住院危重患者AGI的发病和肠内营养的使用情况及其效果,患者涉及ICU、神经外科、胸外科等,患者未行胃肠道手术.早期将各种必需的药物与营养制剂,通过肠内途径应用于需要营养治疗的患者,促进肠道多种功能的代偿,改善肠黏膜屏障作用、减少肠内毒素和细菌的易位,满足机体对营养物质的需要.结果 56名危重患者在急性疾病阶段及时进行了肠康复治疗,促进患者顺利渡过危急病情.经严格统计分析后认为效果满意.早期肠康复对术后并发症起到了预防作用.除提供机体能量外,在维护肠功能、改善肠黏膜屏障、减少肠内毒素、阻止细菌易位、调节肠道微生态和降低肠源性感染等方面也起到了较好的作用.患者的胃内容物一次抽吸量平均为(280.00±10.17) ml/d.所有患者未发生喂食物误吸.结论 AGI患者应及早进行肠康复治疗和护理,胃内容物一次抽吸的定量管理对临床选择肠内营养的时机有较好的指导意义.急性胃肠损伤新概念的提出和分级管理有利于危重患者的康复,对肠内营养的剂量和逐步增加的时限应进一步研究.     

急性缺血性脑卒中患者幽门螺杆菌感染与CRP、PCT关系探讨

目的 探讨急性缺血性脑卒中患者的幽门螺杆菌(HP)感染状况及其与C-反应蛋白(CRP)、降钙素原(PCT)在急性缺血性脑卒中临床上的意义.方法 分析2012年7月-2014年1月在宁波市第二医院神经内科接受治疗的急性缺血性脑卒中患者的临床资料.将入组的急性缺血性脑卒中患者作为观察组,都在发病7d内入院,对照组选择同期门诊的健康体检者.入院治疗次日上午、对照组在体检当天抽取9 ml的肘正中静脉血,分别检测患者的CRP、PCT及HP抗体.比较2组患者的一般资料、Hp感染状况以及Hp感染状况与CRP、PCT的相关性.结果 本研究共纳入研究对象150例,其中观察组患者77例,对照组73例,2组受试者的基线资料差异无统计学意义(P＞0.05);观察组患者的Hp-IgG阳性率(x2=11.72,P＜0.01)、Hp-CIM阳性率(x2=9.770,P＜0.01)均显著高于对照组;Hp现症感染患者[Hp-CIM阳性组,(7.8±1.8) mg/L]、Hp既往感染者[Hp-IgG阳性组,(5.4±1.3) mg/L]及正常对照组[(2.2±0.6)mg/L]所对应的CRP水平比较结果差异具有统计学意义(F=305.3,P＜0.01),且Hp-CIM阳性组患者最高,正常对照组最低;Hp现症感染患者[(1.9±0.7)ng/ml]、Hp既往感染者[(1.4±0.3) ng/ml]及正常对照组[(0.3±0.1)ng/ml]所对应的PCT水平比较结果提示差异具有统计学意义(F=305.3,P＜0.01),且Hp-CIM阳性组患者最高,正常对照组最低.结论 缺血性脑卒中与Hp感染关系密切,而Hp感染状况与CRP和PCT有着一定的相关性.     

急性脑梗死患者血清OX-LDL水平与颈动脉超声用于动脉粥样硬化性脑梗死监测意义分析

目的 :探讨急性脑梗死患者血清OX-LDL水平与颈动脉超声用于监测急性脑梗死临床价值。方法 :选取本院120例动脉粥样硬化性脑梗死患者作为本次研究对象,同时选择同期健康体检的健康人群120例作为对照组,分别检测两组血清OX-LDL水平,采用双通道双深度彩色多普勒血流分析仪对两组人员颈总动脉和颈外动脉及颈内动脉形态和数量及回声特性、大小进行观察,并加以分析。结果 :动脉粥样硬化性脑梗死患者血清OX-LDL水平明显高于对照组;动脉粥样硬化性脑梗死患者早期血清OX-LDL水平越高,其稳定性斑块及无斑块者越少,同时不稳定性斑块患者越多。动脉粥样硬化性脑梗死患者血清OX-LDL水平越高,其发生中、重度狭窄率就会越高。结论 :临床联合血清OX-LDL水平与颈动脉超声检测对动脉粥样硬化性脑梗死患者病情变化监测具有重要价值。     

Eyelid Myeloid Sarcoma: Ominous Presentation of Acute Myelogenous Leukemia

A 19 year-old African American man presented to our clinic for a second opinion about a right upper eyelid mass which had been recalcitrant to treatment for nonspecific orbital inflammation by an outside facility. Examination for systemic causes of the patients eyelid lesion led to a diagnosis of acute myelogenous leukemia (AML) FAB subtype M1. A subsequent biopsy of the eyelid tumor confirmed the diagnosis of a myeloid sarcoma. The patient succumbed to complications from his leukemia within 13 months of presentation. This case report is the first, to our knowledge, of an eyelid myeloid sarcoma as the presenting sign of AML and demonstrates the poor prognosis of this lesion.     

Regurgitations in a Lamb with Acute Coenurosis-A case Report

Coenurosis is a disease of the central nervous system in sheep, caused by Coenurus cerebralis, the larval stage of Multiceps multiceps, which inhabits the small intestine of Canidae. A case of regurgitations in a 2.5 month old lamb with acute coenurosis is being reported. The lamb was presented with a sudden onset of ataxia and regurgitations for 10 days. The post-mortem examination revealed 4 immature C. cerebralis cysts between 0.5 and 1.5 cm in diameter located in the brainstem and cerebellum, and histopathological examination revealed multifocal pyogranulomatous meningoencephalitis, so a diagnosis of acute coenurosis was established. Thus, acute coenurosis should be included in the differential diagnosis of regurgitations in lambs.     

替格瑞洛对急性冠状动脉综合征患者血小板聚集的影响

目的比较替格瑞洛和氯吡格雷对急性冠状动脉综合征(ACS)患者血小板聚集的影响。方法 81例ACS患者被随机分为替格瑞洛组(A组,41例)和氯吡格雷组(B组,40例),比较两组服药前和服药后1、2、4、8、24h及治疗第7天的血小板最大聚集率(PMAR)、血小板聚集抑制率(IPA)及出血事件。结果两组服药前PMAR水平相近(P>0.05)。A组患者服药期间的PMAR均低于B组(P<0.01),IPA及IPA≥50%的患者比例均高于B组(P<0.01)。B组服药后2h的IPA低于服药后8h(P<0.01),而A组两个时间段IPA差异无统计学意义(P>0.05)。两组均只有轻微出血事件。结论在ACS患者,替格瑞洛较氯吡格雷更能有效地抑制血小板聚集;两药短期的安全性相仿。     

急性脑梗死患者血浆 Fg、DD和vWFAg 的检测及临床意义

目的：探讨检测急性脑梗死（ACI）患者纤维蛋白原（Fg）、D‐二聚体（DD）和血管性血友病因子抗原（vWF Ag ）的临床价值。方法选取94例ACI患者作为脑梗死（A ）组,检测治疗前后Fg、DD和vWF Ag变化;同期94例非血栓性疾病患者作为对照（B）组。分析三项指标对ACI的诊断价值。结果 A组治疗前血浆 Fg、DD和vWF Ag值高于B组（P＜0．05）,治疗后降低（P＜0．05）。取Fg＞4.5 g／L、DD＞131μg／L、vWF Ag＞142％为截断值,Fg、DD和vWF Ag诊断ACI的特异度分别为90％、78％和77％,灵敏度分别为21％、50％和82％,准确性分别为60％、65％和80％。结论检测血浆Fg、DD和vWF Ag对ACI诊断均有一定临床价值,以vWF Ag的准确性最高。