Stenotrophomonas maltophilia bacteremia in adults: four years' experience in a medical center in northern Taiwan.

Stenotrophomonas maltophilia has become an important nosocomial pathogen in immunocompromised patients in Taiwan. Patients with underlying diseases such as diabetes, uremia, and solid malignancy are extremely vulnerable to this organism. S. maltophilia bacteremia has a mortality rate of up to 62% if appropriate antibiotics are not instituted early. Knowledge of the risk factors for infection as well as local susceptibility patterns is helpful in determining which patients should receive empirical antibiotics active against S. maltophilia. This study assessed the characteristics of 50 episodes of S. maltophilia bacteremia in 48 patients admitted between March 3, 1999 and May 21, 2003. The new fluoroquinolone levofloxacin showed promising in vitro activity against S. maltophilia in view of the increasing resistance of isolates to trimethoprim-sulfamethoxazole. For patients at risk for S. maltophilia infection, such as those receiving mechanical ventilation in the ICU or those with multiple vascular access devices, the need for antimicrobial agents to which S. maltophilia is normally sensitive should be considered in selecting empiric therapy.     

旋蒴苣苔的化学成分(英文)

目的:研究旋蒴苣苔全草(Boea hygrometrica(Bunge.)R.Br.)的化学成分。方法:利用Diaion HP-20,Toyopearl HW-40,硅胶等柱色谱技术进行分离纯化,根据化合物的光谱数据和理化性质鉴定结构。结果:分离并鉴定了7个化合物的结构,即5,7,3',4'-四羟基-6-甲氧基-8-C-[β-D-木糖-(1→2)]-β-D-葡萄糖黄酮碳苷(1),对羟基苯乙醇(2),3,4-二羟基苯乙醇(3),罗布麻宁(4),阿魏酸(5),1′-O-β-D-(3,4-二羟基苯乙基)-6′-O-咖啡酰基-β-D-芹菜糖(1→3′)-葡萄糖苷(6),龙胆酸(7)。结论:化合物1为新化合物,化合物2-7为首次从该植物中分离得到。     

浅裂鳞毛蕨中一个新二氢黄酮的分离和结构鉴定

目的：研究浅裂鳞毛蕨（Dryopteris sublaeta Ching et Hsu）的化学成分。方法：利用Diaion HP-20，Toyopearl HW-40，Sephadex LH-20，硅胶柱等色谱技术进行分离纯化，根据化合物的理化性质和光谱数据鉴定结构。结果：从浅裂鳞毛蕨中分离并鉴定了6个化合物，分别为：2（S）-5，7，3’-三羟基-6，8-二甲基-4’-甲氧基二氢黄酮，即3’-羟基荚果蕨素（1），荚果蕨素-7-O-β-D-葡萄糖苷（2），菠甾醇（3），菠甾醇-3-O-β-D-葡萄糖苷（4），谷甾醇（5），胡萝卜苷（6）。结论：化合物1为新化合物，化合物2，3，4为首次从鳞毛蕨属植物中分离得到。     

Recovery and Separation of Dysprosium from Waste Neodymium Magnets through Cyphos IL 104 Extraction

In the present study, the extraction of rare earth elements (REEs) from waste neodymium magnets using phosphorus ionic liquid Cyphos IL 104 was investigated. The objective was to recover and separate the heavy REE (Dy) from light REEs (Nd and Pr). Therefore, the experimental parameters of ionic liquid extraction, including contacting time, the initial pH value, extractant concentration, and O/A ratio, have been optimized. The highest separation factor α_Dy/Nd of 45.18 and α_Dy/Pr of 47.93 has been achieved. Following the ionic liquid extraction, the comparison of different stripping agents and the stripping parameters (the concentration of stripping agent and A/O ratio) were also explored. In short terms, this research demonstrates the optimal parameters of Cyphos IL 104 for selectively extracting high REE (Dy) and reveals its potential for recovering and separating REEs in real waste.     

Malignant transformation of oral potentially malignant disorders in Taiwan: An observational nationwide population database study

Oral cancer is one of the leading causes of cancer death, which are mostly preceded by oral potentially malignant disorders (OPMDs). Taiwanese government launched a free oral cancer screening program. The aim of this study was to analyze the malignant transformation rate of OPMDs.This study was based on national-wide oral screening databases. 3,362,232 people were enrolled. Patients clinically diagnosed with leukoplakia, erythroplakia, oral submucosal fibrosis (OSF), oral verrucous hyperplasia (OVH), and oral lichen planus (OLP), from 2010 to 2013, were identified. We followed up OPMD patients in cancer registry databases to analyze the malignant transformation rate.The malignant transformation rates from the highest to the lowest were: OVH > OSF > erythroplakia > OLP > leukoplakia. The malignant transformation rate was 24.55, 12.76, 9.75, 4.23, and 0.60 per 1000 person-years in the OVH, OSF, erythroplakia, leukoplakia, and comparison cohort. The hazard ratio was 8.19 times higher in the OPMD group compared with comparison cohort group, after age and habit adjustment. Female patients with OPMDs had a high risk of malignant transformation.Nationwide screening is very important for early diagnosis. OVH had the highest malignant transformation possibility. Female OPMD patients are a rare but have a relatively high malignant transformation rate.     

经皮颈内静脉长期导管在老年维持性血液透析患者中的临床应用

目的：探讨经皮颈内静脉长期导管在老年维持性血液透析患者中的应用及其常见并发症的防治。方法对2009年12月至2012年12月在中南大学湘雅医院行经皮颈内静脉长期置管的15例维持性血液透析老年患者的临床资料进行回顾性分析,观察置管术后情况、导管的使用情况、常见并发症的防治、透析充分性评价等。结果（1）实施颈内静脉长期置管18例次,其中3例为重新置管,置管成功率100%。（2）导管相关并发症：2例患者术后1周内出现置管处局部渗血;1例出现导管出口感染,2例发生导管相关性血流感染;3例患者出现导管血栓形成;2例诊断导管纤维鞘形成;1例因人为损坏出现导管破裂。经过相应处理后均使问题得到解决。（3）导管使用期限：本组患者长期导管使用时间为4～41个月,除1例死亡（原因为脑出血）,3例为重新置管,余患者仍继续使用。（4）透析充分性评价：15例患者平均尿素下降率为72%,平均尿素清除指数达1.54。结论对于血管条件差无法建立动静脉内瘘的老年血透患者,使用颈内静脉长期导管行血液透析可以达到充分透析;提高置管及导管护理技术、加强健康宣教,能延长导管使用年限,减少导管并发症。     

Increased Risk of Deep Vein Thrombosis and Pulmonary Thromboembolism in Patients with Spinal Cord Injury: A Nationwide Cohort Prospective Study

Background

We investigated the effect of spinal cord injury (SCI) on the development of deep vein thrombosis (DVT) and pulmonary thromboembolism (PE) by conducting a nationwide longitudinal cohort study.

Methods

We studied the entire hospitalized population in Taiwan for the 1998–2008 period, with a follow-up period extending to the end of 2010. We identified SCI patients using the Taiwan National Health Insurance Research Database (NHIRD), and selected a cohort that was 1:4 frequency-matched by age (5-y span), sex, and index year from the general population. We analyzed the risks of DVT and PE using Cox proportional-hazards regression models, which included the demographic variables of sex, age, and comorbidities.

Results

A total of 47,916 SCI patients (62.7% men, mean age of 50.0 y) and 191,664 controls were followed for 308,266 and 1,341,169 person-years, respectively. The adjusted hazard ratio (HR) of DVT and PE development was 2.46-fold and 1.57-fold among the SCI patients, respectively. The highest risk of DVT and PE developed within 3 months after an SCI occurred (HR: 16.9 and 3.64, respectively). The adjusted HR of DVT and PE rose markedly with increasing age. The adjusted HR of DVT was highest among C-spine SCI patients, and the adjusted HR of PE was highest among T-spine SCI patients.

Conclusion

This nationwide prospective cohort study demonstrated that the risk of DVT and PE increased significantly in SCI patients compared with that of the general population. The highest risk of DVT and PE developed within 3 months after an SCI occurred.     

Protective effect of nitric oxide on hepatopulmonary syndrome from ischemia-reperfusion injury

AIM: To evaluate immunological protection of nitric oxide (NO) in hepatopulmonary syndrome and probable mechanisms of ischemia-reperfusion (IR) injury in rat liver transplantation.METHODS: Sixty-six healthy male Wistar rats were randomly divided into three groups (11 donor/recipient pairs). In group II, organ preservation solution was lactated Ringer’s solution with heparin 10  000/μL at 4 °C. In groups I and III, the preservation solution added, respectively, L-arginine or N^G-L-arginine methyl ester (L-NAME) (1 mmol/L) based on group II, and recipients were injected with L-arginine or L-NAME (50 mg/kg) in the anhepatic phase. Grafted livers in each group were stored for 6 h and implanted into recipients. Five rats were used for observation of postoperative survival in each group. The other six rats in each group were used to obtain tissue samples, and executed at 3 h and 24 h after transplantation. The levels of alanine aminotransferase (ALT), tumor necrosis factor (TNF)-α and NO metabolites (NOx) were detected, and expression of NO synthase, TNF-α and intercellular adhesion molecule 1 (ICAM-1) was examined by triphosphopyridine nucleotide diaphorase histochemical and immunohistochemical staining.RESULTS: By supplementing L-arginine to strengthen the NO pathway, a high survival rate was achieved and hepatic function was improved. One-week survival rate of grafted liver recipients in group I was significantly increased (28.8 ± 36.6 d vs 4 ± 1.7 d, P < 0.01) as compared with groups II and III. Serum levels of ALT in group I were 2-7 times less than those in groups II and III (P < 0.01). The cyclic guanosine monophosphate (cGMP) levels in liver tissue and NOx in group I were 3-4 times higher than those of group II after 3 h and 24 h reperfusion, while in group III, they were significantly reduced as compared with those in group II (P < 0.01). The levels of TNF-α in group I were significantly lower than in group II after 3 h and 24 h reperfusion (P < 0.01), while being significantly higher in group III than group II (P < 0.01). Histopathology revealed more severe tissue damage in graft liver and lung tissues, and a more severe inflammatory response of the recipient after using NO synthase inhibitor, while the pathological damage to grafted liver and the recipient’s lung tissues was significantly reduced in group I after 3 h and 24 h reperfusion. A small amount of constitutive NO synthase (cNOS) was expressed in liver endothelial cells after 6 h cold storage, but there was no expression of inducible NO synthase (iNOS). Expression of cNOS was particularly significant in vascular endothelial cells and liver cells at 3 h and 24 h after reperfusion in group II, but expression of iNOS and ICAM-1 was low in group I. There was diffuse strong expression of ICAM-1 and TNF-α in group III at 3 h after reperfusion.CONCLUSION: The NO/cGMP pathway may be critical in successful organ transplantation, especially in treating hepatopulmonary syndrome during cold IR injury in rat orthotopic liver transplantation.     

荔枝核总黄酮对肝纤维化大鼠肝细胞Bcl-2/Bax表达的影响

目的:研究荔枝核总黄酮(total flavone from Litchi Chinensis Sonn,TFL)对二甲基亚硝胺(dimethylnitrosamine,DMN)肝纤维化大鼠肝细胞凋亡的影响及作用机制.腔注射制备大鼠肝纤维化模型,造模的同时,TFL干预组分别以高、低剂量的TFL灌胃6wk进行干预治疗,空白对照组、秋水仙碱组分别以生理盐水、秋水仙碱灌胃作为阴阳性对照.HE及Masson染色观察肝纤维化程度;免疫组织化学二步法检测Bcl-2、Bax的表达;测定血清ALT、AST的水平.结果:模型组大鼠肝组织中Bcl-2、Bax的表达较正常组显著升高(P=0.000),TFL高、低剂量给药组及秋水仙碱组Bcl-2的表达较模型组升高(P=0.000,0.047,0.021),Bax的表达较模型组降低(P=0.000,0.014,0.007),TFL高剂量组与低剂量组比较Bcl-2的表达升高(P=0.018),Bax的表达显著降低(P=0.002).Bcl-2、Bax在秋水仙碱组与TFL低剂量组中的表达无显著性差异(P=0.726,0.767).肝纤维化严重程度与Bax的表达显著正相关(P=0.000);与Bcl-2的表达负相关(P=0.000).空白对照组、TFL高低剂量给药组及秋水仙碱组血清ALT、AST均明显低于模型组,具有显著性差异(P=0.000).低剂量组与秋水仙碱组无显著性差异(P=0.597,0.669).结论:TFL具有较好的抗肝纤维化和改善肝功能的作用,并推测这种作用可能与上调Bcl-2、下调Bax的表达,抑制肝细胞的凋亡有关.