华法林负荷量法抗凝治疗短暂性脑缺血发作的研究

目的 :观察华法林抗凝治疗短暂性脑缺血发作 (TIA)的安全性和疗效。方法 :2 0 0 3年 1月至2 0 0 4年 1月入院的TIA病人 ,适合抗凝治疗者 ,按Roberts依年龄调整华法林负荷量指南用药 ,对照组为 2 0 0 2年 1月至 2 0 0 3年 1月住院的TIA病人 ,并剔除用肝素治疗的病人。结果 :华法林组 10d内无脑卒中发生 ,仅有 4人次再次TIA ,未发现有出血者 ;对照组 10d内脑梗死 6例 ,再次TIA 12人次 ,华法林组于TIA发作后 10d内发生脑梗死及再次TIA较对照组低 (P <0 .0 5 )。结论 :按Roberts华法林负荷量指南抗凝治疗TIA优于非抗凝治疗 ,而且安全     

CCR7信号通路与视网膜新生血管

视网膜新生血管性疾病是致盲的主要原因。趋化因子受体7(C-C chemokine receptor type 7, CCR7)可通过细胞外信号调节激酶(extracellular signal regulate kinase,ERK)通路促进血管内皮生长因子(vascular endothelial growth factor, VEGF)的表达,导致血管渗漏、血管内皮细胞增生以及新生血管形成等改变。趋化因子受体7的检测可指导视网膜新生血管性疾病的诊治。     

Determining the significance of coagulase-negative staphylococci identified in cultures of paired blood specimens from neonates by species identification and strain clonality.

Of 13 paired coagulase-negative staphylococci (CoNS) isolates recovered from cultures of paired blood specimens obtained simultaneously from peripheral sites from neonates with clinical sepsis, 12 were identical species with identical genotypes. Isolation of CoNS in cultures of 2 blood samples obtained simultaneously from separate sites in neonates usually represents true infection.     

Salmonella enterica serotype Choleraesuis: epidemiology, pathogenesis, clinical disease, and treatment

Nontyphoid Salmonella strains are important causes of reportable food-borne infection. Among more than 2,000 serotypes, Salmonella enterica serotype Choleraesuis shows the highest predilection to cause systemic infections in humans. The most feared complication of serotype Cholearesuis bacteremia in adults is the development of mycotic aneurysm, which previously was almost uniformally fatal. The advances in diagnostic techniques, surgical care, and antimicrobial therapy have greatly improved the survival of these patients. However, the recent emergence of serotype Choleraesuis that is resistant to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and, notably, fluoroquinolone antibiotics has aroused concern about the use of these agents for the empirical treatment of systemic infection caused by this organism. In view of the serious implications of the situation, the chain of transmission and mechanism of resistance should be carefully studied to reduce the spread of infection and threat to human health. To date, there are no vaccines available to prevent serotype Choleraesuis infections in humans. The availability, in the near future, of the genome sequence of serotype Cholearesuis will facilitate the development of effective vaccines as well as the discovery of new targets for novel antimicrobial agents.     

Dissemination of extended-spectrum beta-lactamase-producing Enterobacteriaceae in pediatric intensive care units

To study the growing trend of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae in pediatric intensive care units (PICUs), 88 nonrepetitive ESBL-producing isolates were prospectively collected and analyzed by molecular methods during a 16-month period. The emergence and dissemination of ESBL-producing Enterobacteriaceae in PICUs are the consequence of the clonal dissemination of a few epidemic strains along with the horizontal transmission of resistance gene-carrying plasmids among bacterial organisms.     

In vivo acquisition of ceftriaxone resistance in Salmonella enterica serotype anatum

The emergence of resistance to antimicrobial agents within the salmonellas is a worldwide and severe problem. A case of treatment failure due to the emergence of resistance to ceftriaxone in Salmonella enterica serotype Anatum was studied. S. enterica serotype Anatum and Escherichia coli, both of which are susceptible to ceftriaxone, were initially isolated from a diabetic patient hospitalized for the treatment of wound and urinary tract infections. Resistant S. enterica serotype Anatum and E. coli strains were isolated concomitantly 2 weeks after the initiation of ceftriaxone therapy. The patient eventually died of a sepsis caused by the ceftriaxone-resistant salmonella. PCR, nucleotide sequence analysis, and DNA-DNA hybridization identified a bla(CTX-M-3) gene located on a 95.1-kb plasmid from the ceftriaxone-resistant isolates of S. enterica serotype Anatum and E. coli. The plasmid was proved to be conjugative. Molecular fingerprinting showed that the susceptible and resistant strains were genetically indistinguishable. The emergence of resistance to ceftriaxone in S. enterica serotype Anatum was due to the in vivo acquisition of a plasmid containing the bla(CTX-M-3) gene and was the cause for treatment failure in this patient.     

Outbreak of Acinetobacter baumannii bacteremia in a neonatal intensive care unit: clinical implications and genotyping analysis

BACKGROUND: Outbreaks of sepsis associated with have been rarely reported in neonatal intensive care units (NICUs). We describe such an outbreak in a NICU, and the results of molecular epidemiologic investigations are presented. MATERIALS AND METHODS: Between August and September 2000, 6 premature infants hospitalized in a pediatric NICU developed sepsis. Three additional cases had infections during November and December. For an environmental culture survey, 94 environmental specimens and hand washings of all 43 health care workers involved in this unit were examined for the presence of this organism. Two genotyping methods, pulsed field gel electrophoresis of genomic DNA digested with I and infrequent restriction site polymerase chain reaction, were used to analyze the 9 bacteremic isolates and any isolates obtained from the environmental survey and the hand washings. Another 3 bacteremic isolates of collected in the same NICU in 1999 were incorporated as controls. RESULTS: The 9 infants were premature and had birth weights of <1,500 g. Before onset of sepsis 9 infants had received total parenteral nutrition, and 8 infants had had central venous catheters and received intrafat emulsion. Five (5.3%) environmental specimens and 10 (23.3%) hand washing specimens were positive for the organism. Except for the strain from Case 9, the results of both genotyping methods were concordant; 11 patterns were identified by infrequent restriction site polymerase chain reaction and 10 patterns by pulsed field gel electrophoresis. One major genotype was demonstrated in the first 6 bacteremic isolates as well as 3 hand washing isolates. The genotypes of the other 3 bacteremic isolates, the 3 control strains, the 5 environmental isolates and 7 other hand washing isolates were distinct from the genotype of outbreak strains. CONCLUSION: An outbreak of bacteremia in a NICU was clearly demonstrated by the molecular epidemiologic investigation and was possibly transmitted via the hands of health care workers.     

Using novel subcision technique for the treatment of primary essential cutis verticis gyrata

Background  Primary essential cutis verticis gyrata (CVG) is characterized by folds and furrows of the scalp, resembling the convoluted appearance of the brain, and is not associated with other abnormalities. Most patients with CVG are treated with surgical methods, such as scalp reduction; however, surgery may not be suitable for patients in whom the area involved is large.
Methods  A 37-year-old man with primary essential CVG was treated with a scalp subcision technique under local anesthesia.
Results  A successful cosmetic improvement was obtained.
Conclusions  The scalp subcision technique is a safe procedure and should be a treatment option for primary CVG.     

Vancomycin-resistant Enterococcus faecium at a university hospital in Taiwan, 2002–2015: Fluctuation of genetic populations and emergence of a new structure type of the Tn1546-like element

Background/purposes

Vancomycin resistance increased significantly to 31.3% among Enterococcus faecium in 2006 and remained high thereafter at a university hospital in Taiwan. A longitudinal study was retrospectively conducted to characterize these vancomycin-resistant E. faecium (VRE-fm).

Laboratory investigation of a suspected outbreak caused by Providencia stuartii with intermediate resistance to imipenem at a long-term care facility

Background

Providencia stuartii survives well in natural environment and often causes opportunistic infection in residents of long-term care facilities (LTCFs). Clinical isolates of P. stuartii are usually resistant to multiple antibiotics. The bacterium is also naturally resistant to colistin and tigecycline. Treatment of infections caused by carbapenem-resistant P. stuartii is challenging.