Characterization of Healthcare-Associated and Community-Associated Clostridioides difficile Infections among Adults,Canada, 2015–2019

We investigated epidemiologic and molecular characteristics of healthcare-associated (HA) and community-associated (CA) Clostridioides difficile infection (CDI) among adult patients in Canadian Nosocomial Infection Surveillance Program hospitals during 2015–2019. The study encompassed 18,455 CDI cases, 13,735 (74.4%) HA and 4,720 (25.6%) CA. During 2015–2019, HA CDI rates decreased by 23.8%, whereas CA decreased by 18.8%. HA CDI was significantly associated with increased 30-day all-cause mortality as compared with CA CDI (p<0.01). Of 2,506 isolates analyzed, the most common ribotypes (RTs) were RT027, RT106, RT014, and RT020. RT027 was more often associated with CDI-attributable death than was non-RT027, regardless of acquisition type. Overall resistance C. difficile rates were similar for all drugs tested except moxifloxacin. Adult HA and CA CDI rates have declined, coinciding with changes in prevalence of RT027 and RT106. Infection prevention and control and continued national surveillance are integral to clarifying CDI epidemiology, investigation, and control.     

基层医院儿科应用抗菌素状况及葡萄球菌的耐药性调查

目的：观察儿科抗生素的应用状况以及葡萄糖球菌的耐药情况,并对儿科抗生素使用合理性进行评价。方法：选取我院儿科抗生素应用状况数据库资料作为研究对象,分析我院儿科抗生素应用状况、葡萄球菌对不同抗生素的耐药性情况。结果：儿科抗生素使用率较高,平均使用率达90．96％,而且某些单品种抗生素使用较多,微生物送检率达91．29％;葡萄球菌对常用抗生素青霉素、红霉素等的耐药性可达88．0％以上,对万古霉素尚未产生耐药性,辛内吉及呋喃坦啶耐药性较低,低于10％;抗生素二联用情况也比较常见,占35．83％,三联及以上联用情况尚未出现。结论：儿科抗生素使用率比较高,而且葡萄球菌的耐药性情况也较为普遍,临床医护人员需要对此引起重视,合理应用抗生素,保证疗效的同时,预防细菌耐药性的增强。     

大黄素、小檗碱对HepG2细胞胰岛素抵抗的预防作用研究

目的：研究大黄素、小檗碱对HepG2细胞产生胰岛素抵抗的预防作用及机制。方法：首先用MTT法筛选大黄素、小檗碱作用于HepG2细胞的实验浓度,然后用软脂酸诱导HepG2细胞,同时分别加入大黄素、小檗碱干预,并设正常组、对照组进行比较,通过葡萄糖氧化酶法、蒽酮法、RT-PCR法,观察大黄素、小檗碱对HepG2细胞上糖代谢及瘦素长型受体、短型受体mRNA表达水平的影响。结果：对照组成为具有胰岛素抵抗的HepG2细胞,且细胞上瘦素长型及短型受体mRNA的表达水平较正常纽显著下降（P〈0．01）;而大黄素、小檗碱组培养液中葡萄糖含量、细胞内糖原含量以及细胞上瘦素长型及短型受体mRNA的表达水平较正常组无明显改变（P〉0．05）。结论：大黄素、小檗碱均能预防HepG2细胞产生胰岛素抵抗,这一作用与它们影响HepG2细胞上糖代谢及瘦素受体mRNA表达水平有关。     

西拉普利对高血压病人胰岛素抗药性的影响

目的：为探索西拉普利治疗高血压病疗效及其对胰岛素抗药性的影响。方法：采用随机对照法对原发性高血压３０例（男性１６例，女性１４例，年龄４８±ｓ１０ａ），用西拉普利２．５～５．０ｍｇ／ｄ，疗程４ｗｋ。对照组为２０例（男性１１例，女性９例；年龄５２±７ａ），用氢氯噻嗪２５～５０ｍｇ／ｄ，疗程４ｗｋ。结果：西拉普利和氢氯噻嗪都有明显降压作用，但只有西拉普利有改善胰岛素抗药性的效应。结论：西拉普利治疗高血压病人有改善胰岛素抗药性的作用，对糖代谢起良好的影响。     

线叶菊抗耐药性细菌感染有效部位的抗菌活性谱效关系

目的:建立线叶菊指纹图谱,阐明共有峰所代表的化学成分对抗菌药效贡献的大小,揭示其药效物质基础。方法:采用HPLC建立线叶菊的指纹图谱,流动相乙腈-PBS(0.1 mol·L~(-1)磷酸二氢钠与2%冰乙酸1∶1混合)梯度洗脱,检测波长360 nm。通过线叶菊不同批次样品对金黄色葡萄球菌、大肠埃希菌、白色葡萄球菌、副乙型伤寒杆菌和耐药金黄色葡萄球菌的抑制作用来反映其抗菌活性,利用多元线性回归与灰色关联分析方法建立谱效关系。结果:多元线性回归法可知对耐药性金黄色葡萄球菌、大肠埃希菌、金黄色葡萄球菌、白色葡萄球菌和副乙型伤寒杆菌有作用的峰共有9个。灰关联度分析得出异鼠李素3-O-芸香糖苷、异荭草素、异杜荆苷与耐药金黄色葡萄球菌相关;异鼠李素3-O-β-D-葡萄糖苷、东莨菪内酯、杨梅素、木犀草苷、圣次草苷、异槲皮苷与大肠埃希菌和金黄色葡萄球菌相关;木犀草素和槲皮素3-O-芸香糖基-7-O-葡萄糖苷与白色葡萄球菌相关;圣次草苷、芒果苷、杨梅素、芦丁、东莨菪内酯、异鼠李素3-O-β-D-葡萄糖苷与副乙型伤寒杆菌相关,上述抑菌关联度均达到了0.8以上。结论:所建立的HPLC指纹图谱方法简便、重复性良好。     

陆德铭治疗乳腺癌术后转移的经验

陆徳铭教授认为乳腺癌患者术后转移多以正虚为其本,余毒旁窜为其标,治疗谨守扶正祛邪大法,以自拟乳癌术后方健脾益气、调摄冲任扶其正,根据病位,随证选用清热解毒、化痰散结之品祛余毒。     

多药耐药蛋白1和多药耐药相关蛋白5、7在糖尿病小鼠视网膜中表达的变化

目的 观察多药耐药蛋白1(muhidrug resistance 1,MDR1)、多药耐药相关蛋白(multidrug resistance-associated protein,MRP)5和MRP7在不同时期糖尿病小鼠视网膜中的表达变化.方法 通过腹腔注射链脲佐菌素诱导C57 BL/6小鼠建立糖尿病模型,伊文思蓝灌注检测血-视网膜内屏障变化.分别于糖尿病造模成功后的4周、12周和24周取小鼠视网膜,进行实时定量-PCR、免疫荧光、Western blotting等实验,检测各组小鼠视网膜中MDR1、MRP5和MRP7的表达变化.结果 伊文思蓝灌注结果显示在糖尿病12周就出现视网膜渗漏;实时定量-PCR结果发现与对照组相比,随糖尿病进展,MDR1、MRP5和MRP7在4周、12周和24周的表达均呈下降趋势(MDR1:P4周=0.028,P12周=0.003,P24周＜0.001;MRP5:P4周=0.045,P12周=0.009,P24周＜0.001;MRPy7:P4周=0.019,P12周＜0.001,P24周 =0.001),在糖尿病不同时期其变化也呈下降趋势(均为P＜0.05);免疫荧光观察到MDR1、MRP5和MRP7的荧光强度随糖尿病发展逐渐减弱;Western blotting检测可见在4周、12周、24周糖尿病小鼠视网膜中MDR1、MRP5和MRP7的表达均呈下降趋势.结论 在DR早期血-视网膜内屏障会受到破坏,视网膜中外排转运蛋白的表达也会受糖尿病的影响导致不同程度的下降.     

茶多酚抑制MDA生成及对阿霉素在小鼠肝细胞内蓄积的影响

荧光光度法测定 MDA及阿霉素在小鼠肝细胞内的含量 ;研究茶多酚抑制 MDA的生成与阿霉素胞内蓄积的关系。结果表明 ,茶多酚浓度为 1 0 ,2 0 ,40 ,80 ,1 60 mg/L时对 MDA生成的抑制率分别为 44.87% ,1 1 5.1 7% ,1 77.2 5% ,1 81 .98% ,1 82 .37% ,且与剂量成正相关。在·OH诱导下 ,茶多酚浓度为 40 mg/L时 ,可明显增加阿霉素在小鼠肝组织细胞内的蓄积     

浅析代谢综合征的中西医病因病机

代谢综合征(MS)作为一组症候群,因对高血压病、糖尿病、心脑血管病发病作用认识的不断深入以及社会经济不断发展,使人们运动量减少,摄食习惯的改变,生活节奏的加快,造成今天肥胖症等在发展中国家和发达国家的流行.防治代谢综合征,并减少其临床并发症成为今天面临的迫切任务.为探索代谢综合征实质,现对代谢综合征的中西医病因病机学作以浅析.     

DNA methyltransferase-1 in acute myeloid leukaemia: beyond the maintenance of DNA methylation

DNA methylation is considered an essential epigenetic event during leukaemogenesis and the emergence of drug resistance, which is primarily regulated by DNA methyltransferases. DNA methyltransferase-1 (DNMT1) is one of the members of DNA methyltransferases, in charge of maintaining established methylation. Recently, DNMT1 is shown to promote malignant events of cancers through the epigenetic and non-epigenetic processes. Increasing studies in solid tumours have identified DNMT1 as a therapeutic target and a regulator of therapy resistance; however, it is unclear whether DNMT1 is a critical regulator in acute myeloid leukaemia (AML) and how it works. In this review, we summarized the recent understanding of DNMT1 in normal haematopoiesis and AML and discussed the possible functions of DNMT1 in promoting the development of AML and predicting the sensitivity of hypomethylation agents to better understand the relationship between DNMT1 and AML and to look for new hope to treat AML patients.

Key messages

• The function of DNA methyltransferase-1 in acute myeloid leukaemia.
• DNA methyltransferase-1 predicts the sensitivity of drug and involves the emergence of drug resistance.